William Andrew Clark, PHD, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDN2487 Issued in TN

Practice address

807 University Pkwy
Box 70403
Johnson City, TN 37614-6500

Phone

(423) 439-4071

Fax

(423) 439-4060

NPI assigned

Oct 16, 2012

Last updated

Oct 16, 2012By the provider in NPPES

Sex

Male

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 Philosophy

State licenses

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1356694301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PKWY",
            "address_2": "BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376146500",
            "telephone_number": "423-439-4071",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PKWY",
            "address_2": "BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376146500",
            "telephone_number": "423-439-4071",
            "fax_number": "423-439-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WILLIAM",
        "middle_name": "ANDREW",
        "credential": "PHD, RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "LDN2487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LIC",
            "identifier": "LDN0000002487",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Gail Clark
• Mark E Clark, PA
• Megan Brooke Clark, BS
• Regina Ann Clark, BS
• Samantha D Clark, LMSW
• Jonathan Clarke, M.D.
• Laura Elizabeth Clawson-Price, OTR
• Ashley M Claytore, FNP-C
• Clear Path Counseling of TN, LLC
• Megan Christine Cleary, LPTA

• Registered Dietitian in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Registered Dietitian in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; 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.