Active NPI
Christina Clark
- Community Health Worker
- Memphis, TN
National Provider Identifier
1154894988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 7028 Cobblestone Dr
Memphis, TN 38125-2612 - Phone
- (708) 928-3958
- NPI assigned
- Jan 4, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
7028 Cobblestone Dr
Memphis, TN 38125-2612
Mailing address
7028 Cobblestone Dr
Memphis, TN 38125-2612
Phone (708) 928-3958
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000 | Medicaid | TN | |
| 000000 | Other | NON PROFIT |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546560000000",
"number": "1154894988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7028 COBBLESTONE DR",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381252612",
"telephone_number": "708-928-3958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7028 COBBLESTONE DR",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381252612",
"telephone_number": "708-928-3958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHRISTINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-04",
"last_updated": "2019-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000000",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NON PROFIT",
"identifier": "000000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.