Crystal B Clark, FNP-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22378 Issued in SC

Practice address

211 S Pearl St Ste B
Pageland, SC 29728-2261

Phone

(803) 288-9495

Fax

(989) 214-7326

NPI assigned

Oct 29, 2018

Last updated

Jul 23, 2026By the provider in NPPES

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

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Charm Medical and Wellness, LLC

  dba Southern Charm Medical & Wellness

  • Family Medicine Physician
  • Pageland, SC
  • NPI 1659121614
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1154898179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S PEARL ST STE B",
            "city": "PAGELAND",
            "state": "SC",
            "postal_code": "297282261",
            "telephone_number": "843-675-5070",
            "fax_number": "989-214-7326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S PEARL ST STE B",
            "city": "PAGELAND",
            "state": "SC",
            "postal_code": "297282261",
            "telephone_number": "803-288-9495",
            "fax_number": "989-214-7326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRYSTAL",
        "middle_name": "B",
        "name_prefix": "Miss",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-29",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "22378",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "22378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSURE",
            "identifier": "22378",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP5853",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "urn:oid:2.16.111.1.2095187037.1081.1",
            "affiliation": "N",
            "endpointDescription": "Health info exchange address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "211 S Pearl St Ste B",
            "city": "Pageland",
            "state": "SC",
            "country_code": "US",
            "postal_code": "297282261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Debra Blackwell
• Emily Price Blackwell, LPN
• Joann Victoria Blakeney-Nieholson
• Marquita Blakeney, BT
• Carolinas Physicians Network Inc (Pageland Family Medicine)
• Community Transit Care LLC
• Clarissa Covington
• Ronald Eli Dickerson Jr., PHARM D.
• Suzette Dennis Dillard, NP
• DS Transpo

• Family Medicine Physician in Pageland, SC
• Providers in Pageland, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.