Lacey Jane Clark

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

NA Issued in LA

Practice address

8300 Constantin Blvd
Baton Rouge, LA 70809-3489

Phone

(225) 374-1303

NPI assigned

May 24, 2017

Last updated

Nov 21, 2019By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23028/brand/1/csg/1/fhir/r4

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.

• Pediatric Associates of Denham Springs

  • Pediatrics Physician
  • Denham Springs, LA
  • NPI 1134565112
  NPD (past)

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1366970121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9718 HEAVY ANCHOR LN",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773963381",
            "telephone_number": "832-644-1970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 CONSTANTIN BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093489",
            "telephone_number": "225-374-1303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7777 Hennessy Blvd Ste 6004",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708084300",
            "country_code": "US",
            "telephone_number": "225-765-5927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LACEY",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evelyn Elizabeth Clark
• Hollis Anne Clark, DDS
• Jamie Sartwell Clark, GSW,LCSW
• Jessica Clark
• John E Clark
• Latoya S Clark, LPN
• Latrenda W Clark
• Lemuria Atlantis Clark
• Mada Clark
• Merry Lacy Clark, M.S., CCC/SLP

• Pediatrics Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; 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.