Active NPI
Kristen Clark, RD
- Registered Dietitian
- Wyomissing, PA
National Provider Identifier
1194424820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DN007640
- Practice address
- 1220 Broadcasting Rd Ste 101
Wyomissing, PA 19610-3221 - Phone
- (610) 371-8623
- NPI assigned
- Mar 2, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DN007640 | PA | Primary |
Addresses
Primary practice location
1220 Broadcasting Rd Ste 101
Wyomissing, PA 19610-3221
Mailing address
PO Box 13579
Reading, PA 19612-3579
Phone (484) 824-8157
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN007640 | PA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reading Professional Services | Past | Accepting new patients | |
| Phoenixville Clinic Company LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Phoenixville, PA
- NPI 1891866182
-
- Endocrinology, Diabetes & Metabolism Physician
- Reading, PA
- NPI 1457391625
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677715200000",
"number": "1194424820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13579",
"city": "READING",
"state": "PA",
"postal_code": "196123579",
"telephone_number": "484-824-8157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 BROADCASTING RD STE 101",
"city": "WYOMISSING",
"state": "PA",
"postal_code": "196103221",
"telephone_number": "610-371-8623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KRISTEN",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-02",
"last_updated": "2023-03-02",
"certification_date": "2023-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DN007640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyomissing, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.