Mandy Clark, APRN

Key facts

NPI

1104426261

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Nurse Practitioner 363LP0200X

License

A006213 (AR)

Practice address

614 E Emma Ave Ste 300
Springdale, AR 72764-4469

Phone

(479) 751-7417

NPI assigned

Oct 28, 2020

Sex

Female

Sole proprietor

No

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Francis House Nwa, Inc Federally Qualified Health Center (FQHC) · Springdale, AR · NPI 1821838996
  Medicare reassignment NPD AR
• Christian Family Medicine, LLC Family Medicine Physician · Ripley, TN · NPI 1043252620
  Medicare reassignment NPD TN
• St Francis House Nwa, Inc Federally Qualified Health Center (FQHC) · Fayetteville, AR · NPI 1013384288
  NPD
• St Francis House Nwa, Inc Federally Qualified Health Center (FQHC) · West Fork, AR · NPI 1336986785
  NPD
• St. Francis House Nwa, Inc. Federally Qualified Health Center (FQHC) · Rogers, AR · NPI 1710160098
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled (2 enrollments) in TN, AR

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

No

HHS exclusion list flag

The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2023.

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1104426261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE STE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-409-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE STE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-751-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MANDY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-28",
        "last_updated": "2023-12-06",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AR",
            "license": "A006213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springdale, AR

• Christopher Robin Clark, M.D.
• Eleasha Clark, COTA
• Erin Clark, MHPP
• Kristyn Clark
• Logan Clark
• Kenyatta Clay-Roberson, MHPP
• Donald Clay, MD
• Sierra Clay, M.ED
• Clear Creek Wellness
• Michael P Clouatre, MD

All providers in Springdale, AR · Pediatric Nurse Practitioner in Arkansas