Calista Clark
Individual provider Active NPI Community Health Worker · Hartford, WV
NPI 1275212722 · NPPES record last updated Jul 12, 2023
Key facts
- NPI
- 1275212722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 108 Cierra Dr
Hartford, WV 25247-7708 - Phone
- (937) 418-7890
- NPI assigned
- Jul 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
108 Cierra Dr
Hartford, WV 25247-7708
Mailing address
PO Box 384
Hartford, WV 25247-0384
Phone (937) 418-7890
Other providers in Hartford, WV
All providers in Hartford, WV · Community Health Worker in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.