Katherine Somers Clark, MS,RDN,CNSC,LD

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

License

2001013727 Issued in MO

Practice address

2615 E 20TH St
Joplin, MO 64804-1039

Phone

(417) 624-7546

NPI assigned

Oct 22, 2018

Last updated

Oct 22, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1265908818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2443 S CHAPEL RD",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648368403",
            "telephone_number": "417-388-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 E 20TH ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041039",
            "telephone_number": "417-624-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATHERINE",
        "middle_name": "SOMERS",
        "credential": "MS,RDN,CNSC,LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-22",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "MO",
            "license": "2001013727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2001013727",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Joplin (Joplin City Health Department)
• Annie Clark
• Brianna Yvonne Clark, DO
• Cali Clark, DO, MBA
• Daniel Charles Clark, MSW
• Kelly Clark, MS, CCC-SLP
• Matthew Joseph Clark
• Shannon Carol Clark, DDS
• Megan Dawn Clarkin, D.O.
• Morgan Claybrook

• Metabolic Nutrition Registered Dietitian in Joplin, MO
• Providers in Joplin, MO by specialty
• Metabolic Nutrition Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; 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.