Active NPI
Nancy Clark, MS RD
- Registered Dietitian
- Chestnut Hill, MA
National Provider Identifier
1124116116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- #736
- Practice address
- 1300 Boylston St
Health Works Fitness Center
Chestnut Hill, MA 02467 - Phone
- (617) 383-6100
- Fax
- (617) 795-1876
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | #736 | MA | Primary |
Addresses
Primary practice location
1300 Boylston St
Health Works Fitness Center
Chestnut Hill, MA 02467
Mailing address
PO Box 650124
60 Lindbergh Ave
West Newtown, MA 02465
Phone (617) 795-1875
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 402096 | Other | MA | TUFTS HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #736 | MA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124116116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 650124",
"address_2": "60 LINDBERGH AVE",
"city": "WEST NEWTOWN",
"state": "MA",
"postal_code": "02465",
"telephone_number": "617-795-1875",
"fax_number": "617-795-1876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 BOYLSTON ST",
"address_2": "HEALTH WORKS FITNESS CENTER",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "02467",
"telephone_number": "617-383-6100",
"fax_number": "617-795-1876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "NANCY",
"name_prefix": "Ms.",
"credential": "MS RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "#736",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "402096",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chestnut Hill, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.