Kerry R Clark, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI00000348 Issued in WA

Practice address

101 W 8TH Ave
Suite 1100
Spokane, WA 99204-2307

Phone

(509) 474-4060

NPI assigned

Jun 21, 2013

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

Other names 1

• Kerry Scott Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1114366168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190421",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 8TH AVE",
            "address_2": "SUITE 1100",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042307",
            "telephone_number": "509-474-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KERRY",
        "middle_name": "R",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI00000348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kscott217512@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "101 W 8th Ave",
            "address_2": "Suite 1100",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992042307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "SCOTT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karen Clark, R.PH
• Karly Michelle Clark
• Katie Clark, LMP
• Kelsey Nicole Clark, LMFT
• Kendra Rae Clark, OTR/L
• Lavon Clark, LMFT
• Lincoln Clark, DC
• Lindsay Clark, LICSW
• Loretta A Clark, LMP
• Malia Kari Clark

• Registered Dietitian in Spokane, WA
• Providers in Spokane, WA by specialty
• Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.