Miranda Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

29697 Issued in TN

Practice address

4772 Navy Rd Ste a
Millington, TN 38053-1927

Phone

(901) 873-0930

Fax

(901) 873-0931

NPI assigned

Oct 5, 2021

Last updated

Jul 20, 2023By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Hamad Ahmad MD PC

  dba People First Urgent & Primary Care

  • Family Medicine Physician
  • Millington, TN
  • NPI 1588116891
  Medicare reassignment NPD
• Methodist Healthcare Community Care Associates

  • Urgent Care Clinic/Center
  • Cordova, TN
  • NPI 1194839241
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  TN

  Medicare reassignment NPD
• Hamad Ahmad MD PC

  dba People First Urgent & Primary Care

  • Family Medicine Physician
  • Cordova, TN
  • NPI 1962214338
  NPD
• Methodist Healthcare Community Care Associates

  dba MHCCA Health Screening

  • Corporate Health Clinic/Center
  • Memphis, TN
  • NPI 1699941195
  NPD
• Methodist Heatlhcare Community Care Associates

  • Urgent Care Clinic/Center
  • Memphis, TN
  • NPI 1124277967
  NPD

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1407528722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3243 CYPRESS RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381286103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4772 NAVY RD STE A",
            "city": "MILLINGTON",
            "state": "TN",
            "postal_code": "380531927",
            "telephone_number": "901-873-0930",
            "fax_number": "901-873-0931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 Carmen Ln",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "934587729",
            "country_code": "US",
            "telephone_number": "805-332-4568",
            "fax_number": "800-417-9245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MIRANDA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-05",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "29697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF REGISTERED NURSING",
            "identifier": "95021208",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Campbell Clinic PC
• Carlos Alexander DDS PLLC
• Katie Nicole Carter, PHARMD
• Jayne Cartwright
• Shantera L Childs, CPHT
• Sammie Clark, PHARM. D.
• Douglas Cade Coggin, PT, DPT
• Charles Barry Collier, IDC
• Community Chiropractic
• Amy Coontz

• Family Nurse Practitioner in Millington, TN
• Providers in Millington, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.