Mary Suann Clark

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1048104 Issued in TX

Practice address

3801 Scott and White Dr
Killeen, TX 76543-5252

Phone

(254) 680-1100

NPI assigned

Jul 26, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baylor Scott & White Medical Center - Temple Hospital, Temple, TX, CCN 450054
• Adventhealth Central Texas Hospital, Killeen, TX, CCN 450152

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mclark1138505@direct.sw.org

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.

• Scott & White Clinic

  • Internal Medicine Physician
  • Temple, TX
  • NPI 1093779704
  Medicare reassignment Care Compare group NPD
• Scott & White Clinic

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1649820796
  NPD
• Scott & White Clinic

  • Internal Medicine Physician
  • College Station, TX
  • NPI 1922061993
  NPD
• Scott & White Hospital - Taylor

  • Emergency Medicine Physician
  • Taylor, TX
  • NPI 1659366557
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Metroplex Adventist Hospital Inc

  • General Acute Care Hospital
  • Killeen, TX
  • NPI 1629089966
  Care Compare affiliation
• Scott & White Memorial Hospital

  • General Acute Care Hospital
  • Temple, TX
  • NPI 1477516466
  Care Compare affiliation
• Scott & White Memorial Hospital

  • General Acute Care Hospital
  • Temple, TX
  • NPI 1578502613
  Care Compare affiliation

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1255004271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "800-944-0371",
            "fax_number": "254-215-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 SCOTT AND WHITE DR",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765435252",
            "telephone_number": "254-680-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3202 S W S Young Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Killeen",
            "state": "TX",
            "postal_code": "765426538",
            "country_code": "US",
            "telephone_number": "855-876-7246",
            "fax_number": "855-277-5070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "SUANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1048104",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1048104",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mclark1138505@direct.sw.org",
            "affiliation": "N",
            "address_1": "3801 Scott and White Dr",
            "city": "Killeen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765435252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• City of Killeen
• City of Killeen, Texas
• Reeser Leevon Clare, APRN-CNP
• Anjela Clark, LMFT
• Maliyah Clark
• Michaela Breanne Clark
• Robert Damian Clark, PH.D.
• Yvonne Clark, NP
• Georgione Clarke
• Kelsey Clarke

• Family Nurse Practitioner in Killeen, TX
• Providers in Killeen, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.