Clark Family Practice, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

20179 Issued in TN

Legal business name

CLARK FAMILY PRACTICE, PLLC

Practice address

3443 Dickerson Pike Ste 660
Nashville, TN 37207-2519

Phone

(615) 988-1109

Fax

(949) 798-7514

NPI assigned

Dec 2, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Russell Clark, FNP-C

Title

Owner

Phone

(615) 988-1109

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1512172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1396250155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3443 DICKERSON PIKE STE 660",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372072519",
            "telephone_number": "615-988-1109",
            "fax_number": "949-798-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3443 DICKERSON PIKE STE 660",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372072519",
            "telephone_number": "615-988-1109",
            "fax_number": "949-798-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FAMILY PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-02",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-988-1109",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "20179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q034840",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Colleen Clarey, LCSW
• Clarity Evaluation and Assessment Partners
• Clarity Vision Center Inc
• Clark D. Lea, M.D., P.C.
• Clark Family Medical Practice, PLLC
• Gwendolyn Ann Clark Manlove, OTR L
• Anastasia Delores Clark
• Arden Whitehurst Clark, APRN
• Ashley Clark
• Ashley Clark, M.D.

• Primary Care Clinic/Center in Nashville, TN
• Providers in Nashville, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.