Carolyn Clark, AC-CRNP-PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

NP95013648 Issued in CA

Practice address

6010 Hidden Valley Rd Ste 115
Carlsbad, CA 92011-4219

Phone

(760) 797-8494

NPI assigned

Sep 12, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, CA2 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

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

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.

• Mellow Medical Inc a Professional Corporation

  • Psychiatry Physician
  • West Hollywood, CA
  • NPI 1407275886
  Medicare reassignment NPD
• Hefuna Mental Health Wellness LLC

  • Psychiatry Physician
  • Gaithersburg, MD
  • NPI 1629470547

  DC

  Medicare reassignment
• Mark David Levine M.D. Professional Corporation

  dba Mindpath Health

  • Psychiatry Physician
  • Sacramento, CA
  • NPI 1154697944

  Psychiatric/Mental Health

  NPD (past)
• Mark David Levine, MD Burlingame PC

  dba Community Psychiatry Associates

  • Psychiatry Physician
  • San Mateo, CA
  • NPI 1770709263
  NPD (past)

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

{
    "created_epoch": "1410480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786665600000",
    "number": "1124429857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3835 N FREEWAY BLVD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 HIDDEN VALLEY RD STE 115",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920114219",
            "telephone_number": "760-797-8494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAROLYN",
        "credential": "AC-CRNP-PMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-12",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP95013648",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "AC001401",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CJ3M Corporation (Carlsbad Neighborhood Pharmacy)
• Amanda Clairmont
• Chelsea Renee Clapp, M.D.
• Adam Clark
• Alina Rose Clark
• Clayton Rosell Clark, D.D.S.
• Elysia Clark
• Erin Elizabeth Clark, PSY.D.
• Lacie Clark
• Meghan Clark

• Psychiatric/Mental Health Nurse Practitioner in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; 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.