Stacey Ann Clark, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME0070966 Issued in FL

Practice address

1447 Medical Park Blvd
#402
Wellington, FL 33414

Phone

(561) 790-2600

Fax

(561) 790-1535

NPI assigned

Feb 2, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Pediatric Center

  • Pediatrics Physician
  • Wellington, FL
  • NPI 1528003365
  NPD (past)

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301356800000",
    "number": "1285606574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 MEDICAL PARK BLVD",
            "address_2": "#402",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "33414",
            "telephone_number": "561-790-2600",
            "fax_number": "561-790-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1447 MEDICAL PARK BLVD",
            "address_2": "#402",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "33414",
            "telephone_number": "561-790-2600",
            "fax_number": "561-790-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STACEY",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2011-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME0070966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47177100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiornow Inc.
• Ruth Marie Chirichello, PYA
• Christine a. Klepp MD PA (Horizon Anesthsia Associates)
• Christopher Devine DO PA
• Jessica Ann Clark, MD
• Deon Treseata Clarke
• Sabine Clarke, AP
• Ghislene Clermont, APRN-BC
• Christine Lynn Cline, PT
• Clinical Home Care, Inc.

• Pediatrics Physician in Wellington, FL
• Providers in Wellington, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; 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.