Active NPI
Ronda Clark, FNP
- Family Nurse Practitioner
- Mount Juliet, TN
National Provider Identifier
1457727984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 25016
- Practice address
- 45 W Caldwell St Ste a
Mount Juliet, TN 37122-2906 - Phone
- (615) 622-6080
- Fax
- (615) 622-6133
- NPI assigned
- Aug 19, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 25016 | TN | Primary |
Addresses
Primary practice location
45 W Caldwell St Ste a
Mount Juliet, TN 37122-2906
Mailing address
45 W Caldwell St Ste a
Mount Juliet, TN 37122-2906
Phone (615) 622-6080
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | www.backtobasicsfamilypractice.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Interoperability endpoints
- ronda.clark@772032128417796.direct.elationemr.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637884800000",
"number": "1457727984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 W CALDWELL ST STE A",
"city": "MOUNT JULIET",
"state": "TN",
"postal_code": "371222906",
"telephone_number": "615-622-6080",
"fax_number": "615-622-6133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 W CALDWELL ST STE A",
"city": "MOUNT JULIET",
"state": "TN",
"postal_code": "371222906",
"telephone_number": "615-622-6080",
"fax_number": "615-622-6133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RONDA",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-19",
"last_updated": "2021-11-26",
"certification_date": "2021-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "25016",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "www.backtobasicsfamilypractice.com",
"affiliation": "N",
"endpointDescription": "website",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "web",
"address_1": "45 W Caldwell St Ste A",
"city": "Mount Juliet",
"state": "TN",
"country_code": "US",
"postal_code": "371222906",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Mount Juliet, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.