Clear Creek Wellness

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

CLEAR CREEK WELLNESS

Practice address

5203 Willow Creek Dr Ste B
Springdale, AR 72762-0876

Phone

(479) 301-8970

NPI assigned

Mar 4, 2024

Last updated

Sep 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Heron Martin, APRNNPI 1932591617

Title

Owner

Phone

(479) 283-9958

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Heron B Martin, APRN

  • Family Nurse Practitioner
  • Springdale, AR
  • NPI 1932591617
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1215794599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 SPRINGDALE AVE # 8050",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644358",
            "telephone_number": "479-283-9958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5203 WILLOW CREEK DR STE B",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727620876",
            "telephone_number": "479-301-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR CREEK WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "HERON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-283-9958",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Clark
• Mandy Clark, APRN
• Kenyatta Clay-Roberson, MHPP
• Donald Clay, MD
• Sierra Clay, M.ED
• Michael P Clouatre, MD
• Omega Clouse, LAC
• Jaqulyn Clover, OTD, OTR/L
• Harrison Cobb, M.D.
• Jerri Cobb

• Family Nurse Practitioner in Springdale, AR
• Providers in Springdale, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.