Kina Annette Johnson Clark, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY16066 Issued in CA

Practice address

3724 Atherton Rd Ste 100
Rocklin, CA 95765-3717

Phone

(916) 726-4030

Fax

(916) 786-3080

NPI assigned

Jul 25, 2006

Last updated

Jun 15, 2024By 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 names 1

• Dr. Kina Annette Clark Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hearthstone Counseling Services, Inc.

  • Clinical Psychologist
  • Roseville, CA
  • NPI 1891787644
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718409600000",
    "number": "1326061813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 LEAD HILL BLVD STE 110",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612997",
            "telephone_number": "916-532-0996",
            "fax_number": "916-786-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3724 ATHERTON RD STE 100",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957653717",
            "telephone_number": "916-726-4030",
            "fax_number": "916-786-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON CLARK",
        "first_name": "KINA",
        "middle_name": "ANNETTE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2024-06-15",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KINA",
            "last_name": "CLARK",
            "middle_name": "ANNETTE",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jodi Jewell
• Dayanna Michelle Jimenez
• Jacqueline Jimenez
• Shawn Tiffany Jobes, LMFT
• Valerie L Jobrack, LMFT
• Brandon Johnson
• Cassidy Josephine Johnson
• Joshua Lamar Johnson
• Kristin Johnson, BCBA
• Logan Johnson

• Clinical Psychologist in Rocklin, CA
• Providers in Rocklin, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.