Shawna Clark, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9702 Issued in TN

Practice address

5366 Mendenhall Mall
Memphis, TN 38115-4505

Phone

(901) 701-2730

Fax

(901) 271-6195

NPI assigned

Jul 16, 2013

Last updated

Apr 17, 2015By 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

Enrolled in TN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Christ Community Health Services Inc

  dba Christ Community Health SVCS Inc

  • Federally Qualified Health Center (FQHC)
  • Memphis, TN
  • NPI 1982686614
  Medicare reassignment NPD
• Christ Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, TN
  • NPI 1871299297
  NPD

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429228800000",
    "number": "1417398553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5366 MENDENHALL MALL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381154505",
            "telephone_number": "901-701-2730",
            "fax_number": "901-271-6195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 MENDENHALL MALL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381154505",
            "telephone_number": "901-701-2730",
            "fax_number": "901-271-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHAWNA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-16",
        "last_updated": "2015-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "9702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Nikita Clark
• Paul A Clark II, DDS
• Peyton Lain Clark, PA-C
• Ricketta Clark, NP
• Sally Clark, NP
• Tamara M Clark
• Trent Murray Clark, DO
• William Ray Clark II, PA-C
• Zina Renee Clark
• Audrey F Clarke, LPN

• General Practice Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; 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.