Kacy Clark

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1201 Shaffer Rd
Building 1, Suite a
Santa Cruz, CA 95060

Phone

(831) 420-0120

NPI assigned

Jul 10, 2024

Last updated

Jul 10, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1255178927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SHAFFER RD",
            "address_2": "BUILDING 1, SUITE A",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "95060",
            "telephone_number": "831-420-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SHAFFER RD",
            "address_2": "BUILDING 1, SUITE A",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "95060",
            "telephone_number": "831-420-0120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gianluca Ciulla, CMT
• Ellen Clack
• Adriana Del Pilar Clark, DDS
• Derrick J Clark, PHD
• Jennifer Clark, LMFT
• Meg Kristine Clark
• Ron Wayne Clark
• Thomasina Clark
• Alison Beth Clarke
• Debbie Clarke

• Community Health Worker in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.

Verify at the official NPI Registry.