Active NPI
Nancy Fowler Clark, NP
- Nurse Practitioner
- Washington, DC
National Provider Identifier
1144263229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN62921
- Practice address
- 110 Irving St NW
Suite 2A38
Washington, DC 20010-2976 - Phone
- (202) 877-0788
- NPI assigned
- Jun 14, 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN62921 | DC | Primary |
Addresses
Primary practice location
110 Irving St NW
Suite 2A38
Washington, DC 20010-2976
Mailing address
110 Irving St NW
Suite 2A38
Washington, DC 20010-2976
Phone (202) 877-0788
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036601700 | Medicaid | DC | |
| 407365700 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250219003684 | VA | Order and Referring Only - Nurse Practitioner | 0244273324 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN62921 | DC | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1144263229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 IRVING ST NW",
"address_2": "SUITE 2A38",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200102976",
"telephone_number": "202-877-0788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 IRVING ST NW",
"address_2": "SUITE 2A38",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200102976",
"telephone_number": "202-877-0788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "NANCY",
"middle_name": "FOWLER",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-14",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "DC",
"license": "RN62921",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036601700",
"state": "DC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "407365700",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.