Active NPI
Kristi M Clark, MA
- Audiologist
- South Charleston, WV
National Provider Identifier
1376973834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- A-0211
- Practice address
- 313 Maccorkle Ave SW
South Charleston, WV 25303-1263 - Phone
- (304) 744-2300
- Fax
- (304) 744-8195
- NPI assigned
- Nov 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | A-0211 | WV | Primary |
| Audiologist | 231H00000X | A.01642 | OH |
Addresses
Primary practice location
313 Maccorkle Ave SW
South Charleston, WV 25303-1263
Mailing address
313 Maccorkle Ave SW
South Charleston, WV 25303-1263
Phone (304) 744-2300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A.01642 | OH | MD | Audiologist |
| A-0211 | WV | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Princeton Audiology Clinic, Inc., | Audiologist | Past | Accepting new patients |
| Princeton Audiology Clinic, Inc., | Audiologist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Audiologist
- Bluefield, WV
- NPI 1598981524
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407369600000",
"number": "1376973834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 MACCORKLE AVE SW",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253031263",
"telephone_number": "304-744-2300",
"fax_number": "304-744-8195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 MACCORKLE AVE SW",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253031263",
"telephone_number": "304-744-2300",
"fax_number": "304-744-8195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KRISTI",
"middle_name": "M",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-20",
"last_updated": "2014-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "WV",
"license": "A-0211",
"primary": true
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "OH",
"license": "A.01642",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.