Mandy Clark, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

A006213 Issued in AR

Practice address

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

Phone

(479) 751-7417

NPI assigned

Oct 28, 2020

Last updated

Dec 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, AR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• St Francis House Nwa, Inc

  dba Community Clinic Central Junior High

  • Federally Qualified Health Center (FQHC)
  • Springdale, AR
  • NPI 1821838996
  Medicare reassignment NPD
• Christian Family Medicine, LLC

  dba Christian Family Medicine and Pediatrics

  • Family Medicine Physician
  • Ripley, TN
  • NPI 1043252620
  Medicare reassignment NPD
• St Francis House Nwa, Inc

  dba Community Clinic Fayetteville Medical

  • Federally Qualified Health Center (FQHC)
  • Fayetteville, AR
  • NPI 1013384288
  NPD
• St Francis House Nwa, Inc

  dba Community Clinic West Fork

  • Federally Qualified Health Center (FQHC)
  • West Fork, AR
  • NPI 1336986785
  NPD
• St. Francis House Nwa, Inc.

  dba Community Clinic Springdale Medical

  • Federally Qualified Health Center (FQHC)
  • Springdale, AR
  • NPI 1699785089
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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": []
}

• 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

• Pediatric Nurse Practitioner in Springdale, AR
• Providers in Springdale, AR by specialty
• Pediatric Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.