Active NPI
Raven Clark, NP
- Nurse Practitioner
- Marietta, GA
National Provider Identifier
1427776160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN259021
- Practice address
- 100 Piedmont Rd NE
Marietta, GA 30066-3636 - Phone
- (770) 795-9844
- NPI assigned
- Aug 18, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN259021 | GA | Primary |
| Family Nurse Practitioner | 363LF0000X | RN259021 | GA |
Addresses
Primary practice location
100 Piedmont Rd NE
Marietta, GA 30066-3636
Mailing address
100 Piedmont Rd NE
Marietta, GA 30066-3636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2782 N Cobb Pkwy
Kennesaw, GA 30152-3472
Phone (866) 389-2727
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Interoperability endpoints
- raven.clark@krogerhealth.eclinicaldirectplus.com
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672963200000",
"number": "1427776160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 PIEDMONT RD NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300663636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PIEDMONT RD NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300663636",
"telephone_number": "770-795-9844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RAVEN",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-18",
"last_updated": "2023-01-06",
"certification_date": "2023-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "GA",
"license": "RN259021",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN259021",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.
- 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.