Crystal Clark

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

091485 Issued in NC

Practice address

650 Highland Ave # 100
Winston Salem, NC 27101-4304

Phone

(336) 607-8523

NPI assigned

Jun 1, 2021

Last updated

Jun 1, 2021By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1194391185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HIGHLAND AVE # 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014304",
            "telephone_number": "336-607-8523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NC",
            "license": "091485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adele Clark, PA
• Annie Clark
• Caroline Lee Clark, MD
• Cassidy Rae Clark, PA-C
• Cheryl Denise Clark, LMBT,MMP
• Debra Clark, PA-C
• Denise Ray Clark, CRNA
• Elspeth Clark, D.O.
• Heather Lynn Clark, MD, PHD
• Heather Marie Nettles Clark, M.D.

• Licensed Practical Nurse in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Licensed Practical Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.