Individual provider Active NPI

Joyce Clark

  • Licensed Practical Nurse
  • Salem, NH
National Provider Identifier
1194176958
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
2-027063 Issued in AL
Practice address
2 Keewaydin Dr
Salem, NH 03079-2839
Phone
(800) 995-2673
Fax
(888) 979-6551
NPI assigned
Jun 23, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 2-027063 AL Primary
Licensed Practical Nurse 164W00000X PN935011 FL
Licensed Practical Nurse 164W00000X LPN13843 ME
Licensed Practical Nurse 164W00000X LPN-23090 NM

Addresses

Primary practice location

2 Keewaydin Dr
Salem, NH 03079-2839

Mailing address

2 Keewaydin Dr
Salem, NH 03079-2839
Phone (800) 995-2673

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

State licenses

LicenseStateTypeSpecialty
2-027063ALMDLicensed Practical Nurse
PN935011FLMDLicensed Practical Nurse
LPN13843MEMDLicensed Practical Nurse
LPN-23090NMMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1194176958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 KEEWAYDIN DR",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "030792839",
            "telephone_number": "800-995-2673",
            "fax_number": "888-979-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 KEEWAYDIN DR",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "030792839",
            "telephone_number": "800-995-2673",
            "fax_number": "888-979-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOYCE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AL",
            "license": "2-027063",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN935011",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "ME",
            "license": "LPN13843",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NM",
            "license": "LPN-23090",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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.