Shannon L Clark, RN CCM

Primary specialty

School Registered NurseTaxonomy code 163WS0200X

License

242334 Issued in AZ

Practice address

1115 W 5TH St
Tempe, AZ 85281-2510

Phone

(480) 929-9909

Fax

(480) 804-0384

NPI assigned

Sep 8, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1255052031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 W 5TH ST",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852812510",
            "telephone_number": "480-929-9909",
            "fax_number": "480-804-0384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W 5TH ST",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852812510",
            "telephone_number": "480-929-9909",
            "fax_number": "480-804-0384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNON",
        "middle_name": "L",
        "credential": "RN CCM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "AZ",
            "license": "242334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Shannon.clark@tempeschools.org",
            "affiliation": "Y",
            "endpointDescription": "school",
            "affiliationName": "Tempe School District #3",
            "address_1": "1115 W 5th St",
            "city": "Tempe",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852812510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lisa T Clark, LPC
• Mariana Marisela Clark, LPC
• Melissa Clark, ND
• Mlee R Clark, LMT, CLT
• Rhonda Nicole Clark, PHARMD
• Taylor Leigh Clark
• Brian Joseph Clarke, LAC
• Kathleen Maffett Clarke, LCSW
• Sarah Grace Clay, BA, IBCLC, RLC
• Christine Elizabeth Claybrook

• School Registered Nurse in Tempe, AZ
• Providers in Tempe, AZ by specialty
• School Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.