Debra Clark, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5007863 Issued in NC

Practice address

1040 Vinehaven Dr NE
Concord, NC 28025-2438

Phone

(704) 784-1010

Fax

(704) 784-1013

NPI assigned

Aug 10, 2015

Last updated

Aug 2, 2024By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dclark815862@direct.novanthealth.org

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.

• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group. LLC

  dba Novant Health Pediatric After Hours Care

  • Pediatrics Physician
  • Charlotte, NC
  • NPI 1023727542
  NPD
• Concord Children's Clinic

  • Pediatrics Physician
  • Concord, NC
  • NPI 1679589212
  NPD (past)
• Novant Health Medical Group, LLC

  dba Novant Health Northlake Dermatology

  • Dermatopathology Physician
  • Huntersville, NC
  • NPI 1396751640
  NPD (past)

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1336525625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 VINEHAVEN DR NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252438",
            "telephone_number": "704-784-1010",
            "fax_number": "704-784-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 VINEHAVEN DR NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252438",
            "telephone_number": "704-784-1010",
            "fax_number": "704-784-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEBRA",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-10",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5007863",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5007863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336525625",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Clark, PHARMD
• Brittney K Clark
• Camille Danielle Clark, BIRTH DOULA
• Catherine Clark
• Christopher Michael Clark, DDS
• Devin Clark, LCMHC-A, NCC
• Dion Crimson Clark, MS
• John Philip Clark, PHARMD
• Jymon Tirae Clark, PHARMD
• Kamryn Clark

• Pediatric Nurse Practitioner in Concord, NC
• Providers in Concord, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.