Kerrianne Maria Clark, AU.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

2201001627 Issued in VA

Practice address

8314 Traford LN Ste C
Springfield, VA 22152-1661

Phone

(703) 536-1666

Fax

(703) 522-2483

NPI assigned

Apr 5, 2016

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 DC

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear Nose and Throat Specialists of Northern VAGroup PAC ID 6608761762, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclark@entnova.emadirect.md

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.

• Ear Nose & Throat Specialists of Northern VA

  • Otolaryngology Physician
  • Springfield, VA
  • NPI 1760588628

  DC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1376906420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8314 TRAFORD LN STE C",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221521661",
            "telephone_number": "703-536-1666",
            "fax_number": "703-522-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8314 TRAFORD LN STE C",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221521661",
            "telephone_number": "703-536-1666",
            "fax_number": "703-522-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KERRIANNE",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-05",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "VA",
            "license": "2101002111",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "VA",
            "license": "2201001627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle F Ciuffetelli, PHARMD
• Clarity Health Care Services LLC
• Ann-Marie Clark
• Destiny Clark
• Jordan Amanda Clark, RBT
• Megan Clark, OTR/L, CNT
• Nancy Jean Clark, IBCLC
• Trevor Joseph Claveau, RBT
• Dawn Clements, RBT
• Jenna Clemons, PHARMD

• Audiologist in Springfield, VA
• Providers in Springfield, VA by specialty
• Audiologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.