NPIMap

Individual provider Active NPI

Gina Clark, APRN

  • Primary Care Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1174912406
Registry record updated Aug 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
3008878 Issued in KY
Practice address
4200 Gardiner View Ave
Louisville, KY 40213-1877
Phone
(502) 456-0494
Fax
(502) 456-0496
NPI assigned
Jan 9, 2015
Last updated
Aug 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3008878 KY
Gerontology Nurse Practitioner 363LG0600X 3008878 KY
Primary Care Nurse Practitioner 363LP2300X 3008878 KY Primary

Addresses

Primary practice location

4200 Gardiner View Ave
Louisville, KY 40213-1877

Mailing address

3120 Runnymede Rd
Louisville, KY 40222-6144
Phone (502) 657-1076

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150312000921 KY Practitioner - Nurse Practitioner 0446576326 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Louisville School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
US Psychiatry PLLCGroup PAC ID 4385937598, 12 clinicians

Practice addresses (Care Compare)

5807 Harrods Glen Dr
Prospect, KY 40059-7650
Phone (502) 419-0410

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3008878KYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
US Psychiatry PLLC Nurse Practitioner CurrentSince Aug 1, 2019 Accepting new patients
Uofl Health-Louisville Inc Past Accepting new patients
Pearl Medical Practice PLLC PastSince Jan 31, 2021 Accepting new patients
US Family Care Psychiatry PLLC Nurse Practitioner PastSince Mar 1, 2025 Accepting new patients

Locations

7408 Highway 329
Crestwood, KY 40014
Phone (502) 648-3334

3050 Rio Dosa Dr
Lexington, KY 40509
Phone (859) 268-6475

1100 E Market St
Louisville, KY 40206
Phone (502) 596-1000

1313 Saint Anthony Pl
Louisville, KY 40204
Phone (502) 587-7001

1850 Bluegrass Ave
#U
Louisville, KY 40215

2020 Newburg Rd
Louisville, KY 40205
Phone (502) 315-1458

2020 Newburg Rd
#U
Louisville, KY 40205

2823 Frankfort Ave
Louisville, KY 40206
Phone (502) 893-0241

Organizations & group practices 4

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.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1174912406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 RUNNYMEDE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402226144",
            "telephone_number": "502-657-1076",
            "fax_number": "888-959-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 GARDINER VIEW AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131877",
            "telephone_number": "502-456-0494",
            "fax_number": "502-456-0496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GINA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-09",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3008878",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "KY",
            "license": "3008878",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "KY",
            "license": "3008878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.