Roberta Anne Clark, APN

Primary specialty

Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X

License

AO1898 ANP Issued in AR

Practice address

2710 S Rife Medical LN
Rogers, AR 72758-1452

Phone

(479) 338-3331

Fax

(479) 338-2274

NPI assigned

Jun 8, 2007

Last updated

May 16, 2022By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Washington Regional Medical System

  dba Washington Regional Hospital Medicine Group

  • Hospitalist Physician
  • Fayetteville, AR
  • NPI 1306801485
  NPD (past)

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1184827891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 S RIFE MEDICAL LN",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-338-3331",
            "fax_number": "479-338-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 S RIFE MEDICAL LN",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-338-3331",
            "fax_number": "479-338-2274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Marshall St",
            "address_2": "Slot 512",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722023510",
            "country_code": "US",
            "telephone_number": "501-364-1244",
            "fax_number": "501-364-0445",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Childrens Pl",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101002",
            "country_code": "US",
            "telephone_number": "314-454-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROBERTA",
        "middle_name": "ANNE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "AR",
            "license": "AO1898 ANP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "endpointDescription": "BJC",
            "affiliationName": "St. Louis Children's Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Childrens Pl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• City of Rogers
• Bethany Clair, COTA/L
• Clarity Wellness & Psychiatry, LLC
• Emily Christine Clark
• Nicole Clark, SLP
• Ryan Clark, PT, DPT
• Stephanie M Clark
• Teresa Clark, MD
• Joyce Clarkson, MA CCC-SLP
• Deborah Jane Clay, LPC

• Critical Care Neonatal Nurse Practitioner in Rogers, AR
• Providers in Rogers, AR by specialty
• Critical Care Neonatal Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; 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.