Active NPI
Kimberly Renee Clark, SLP
- Speech-Language Pathologist
- Cary, NC
National Provider Identifier
1255227013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2204001621
- Practice address
- 5625 Dillard Dr
Cary, NC 27518-9226 - Phone
- (919) 431-7400
- NPI assigned
- Jun 17, 2025
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2204001621 | VA | Primary |
Addresses
Primary practice location
5625 Dillard Dr
Cary, NC 27518-9226
Mailing address
4106 Ashmere Cir
Dumfries, VA 22025-1516
Phone (571) 435-6639
Other practice location 1
14715 Bristow Rd
Manassas, VA 20112-3945
Phone (703) 791-7200
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2204001621 | VA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783209600000",
"number": "1255227013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4106 ASHMERE CIR",
"city": "DUMFRIES",
"state": "VA",
"postal_code": "220251516",
"telephone_number": "571-435-6639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5625 DILLARD DR",
"city": "CARY",
"state": "NC",
"postal_code": "275189226",
"telephone_number": "919-431-7400"
}
],
"practiceLocations": [
{
"address_1": "14715 Bristow Rd",
"address_purpose": "LOCATION",
"city": "Manassas",
"state": "VA",
"postal_code": "201123945",
"country_code": "US",
"telephone_number": "703-791-7200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "KIMBERLY",
"middle_name": "RENEE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-17",
"last_updated": "2026-07-05",
"certification_date": "2026-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2204001621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.