Dominique Clark, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

27344 Issued in TN

Practice address

1540 Appling Care LN
Cordova, TN 38016-4957

Phone

(901) 444-3950

NPI assigned

Feb 25, 2020

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

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, 737 clinicians

Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Crossroads Urgent Care PLLCGroup PAC ID 8325117484, 181 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dclark24978@mlh.direct-ci.com

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.

• Crossroads Urgent Care PLLC

  • Family Medicine Physician
  • Murfreesboro, TN
  • NPI 1366644361

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Spring Hill, TN
  • NPI 1134452865
  Medicare reassignment Care Compare group NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  Nurse Practitioner, TN

  Medicare reassignment Care Compare group NPD
• Germantown Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Germantown, TN
  • NPI 1518747526
  Medicare reassignment NPD
• Methodist North Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Memphis, TN
  • NPI 1801677083
  Medicare reassignment NPD
• Methodist South Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Memphis, TN
  • NPI 1609657873
  Medicare reassignment NPD
• Methodist University Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Memphis, TN
  • NPI 1023899291
  Medicare reassignment NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Hoover, AL
  • NPI 1538686498

  Nurse Practitioner, TN

  Medicare reassignment NPD
• Crossroads Urgent Care PLLC

  • Rural Health Clinic/Center
  • South Pittsburg, TN
  • NPI 1427781129

  Nurse Practitioner

  NPD
• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774
  NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Ocoee, FL
  • NPI 1326906843
  NPD
• Advanced Pain Treatment Centers, PC

  • Interventional Pain Medicine Physician
  • Jackson, TN
  • NPI 1932334828
  NPD (past)

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1346874716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 APPLING CARE LN STE 105",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380164947",
            "telephone_number": "901-444-3970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 APPLING CARE LN",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380164957",
            "telephone_number": "901-444-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DOMINIQUE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-25",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "TN",
            "license": "174756",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "27344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saleem A Choudhri, MD
• Thomas Paul Chu, M.D.
• Angela Church, FNP
• Alicia M Ciarloni, NP-C
• Courtney Meadows Clark, PA
• Jessiana Clark, BA
• Julia Clark, RBT
• Kaleigh Clark, LCSW
• Lisa L Clark, PH.D.
• Tanecia Clark

• Family Nurse Practitioner in Cordova, TN
• Providers in Cordova, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; 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.