Susan Marie Clark, C.R.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R157798 Issued in MD

Practice address

301 Randolph St
Denton, MD 21629-1243

Phone

(410) 479-4306

Fax

(410) 479-1714

NPI assigned

Aug 1, 2006

Last updated

Jun 30, 2008By 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

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214784000000",
    "number": "1326055534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 RANDOLPH ST",
            "city": "DENTON",
            "state": "MD",
            "postal_code": "216291243",
            "telephone_number": "410-479-4306",
            "fax_number": "410-479-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 RANDOLPH ST",
            "city": "DENTON",
            "state": "MD",
            "postal_code": "216291243",
            "telephone_number": "410-479-4306",
            "fax_number": "410-479-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "C.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R157798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "521116591",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "521116591",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS RENDERING",
            "identifier": "89583301",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9924498",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPPO",
            "identifier": "766408",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY PARTNERS",
            "identifier": "207884",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "784381000",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND PHYSICIANS CARE",
            "identifier": "521116591",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CF BC/BS GRP/GHMSI/BL CHO",
            "identifier": "T5880040",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INFORMED",
            "identifier": "521116591",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Choptank Community Health System, Inc. (Denton Elementary School SBHC)
• Choptank Community Health System, Inc. (Choptank Community Health System Dental)
• Choptank Community Health System, Inc. (Choptank Community Health Oral Health Outreach Services)
• Choptank Community Health System, Inc. (Lockerman Middle School SBHC)
• Carla Lynn Clark-Guthrie, MSW
• Lisa Clough, RDH
• Deborah Colborn, OTR-L
• Community Behavioral Health, LLC
• Community Behavioral Health, LLC
• Community Behavioral Health, LLC

• Family Nurse Practitioner in Denton, MD
• Providers in Denton, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.