S Kathleen Clark, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD0000015766 Issued in TN

Practice address

1132 Dow St
Murfreesboro, TN 37130-2486

Phone

(615) 896-2617

NPI assigned

Oct 26, 2006

Last updated

Jan 22, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1174608137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 CHERRY LN",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371303935",
            "telephone_number": "615-896-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 DOW ST",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371302486",
            "telephone_number": "615-896-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "S",
        "middle_name": "KATHLEEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "MD0000015766",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TN",
            "license": "MD0000015766",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3032646",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNESSEE BLUE CROSS BLUE",
            "identifier": "0018534",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110025193",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mallory Clark, SLP
• Patrick W. Clark, M.D.
• Penny Abel Clark, LAPSW
• Richie D Clark, PHARMD
• Robert Douglas Clark, LCSW
• Stephen Wesley Clark, MD
• Stevie Leigh Clark, ED.S.
• Diana Marie Clarke, COTA
• Kimara Clarke, LPC-MHSP
• Jenna R Claxton, NP

• Dermatology Physician in Murfreesboro, TN
• Providers in Murfreesboro, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.

Verify at the official NPI Registry.