Active NPI
Ashley Noel Joyles Clark, MD
- Psychiatry Physician
- Kankakee, IL
National Provider Identifier
1205683281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 1538208210
- Practice address
- 350 N Wall St
Kankakee, IL 60901-2901 - Phone
- (815) 933-1671
- NPI assigned
- May 6, 2024
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 1538208210 | IL | Primary |
Addresses
Primary practice location
350 N Wall St
Kankakee, IL 60901-2901
Mailing address
350 N Wall St
Kankakee, IL 60901-2901
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1538208210 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714953600000",
"number": "1205683281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 N WALL ST",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 N WALL ST",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012901",
"telephone_number": "815-933-1671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ASHLEY",
"middle_name": "NOEL JOYLES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-06",
"last_updated": "2024-05-06",
"certification_date": "2024-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "1538208210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.