Crystal Clark

Primary specialty

Adult CompanionTaxonomy code 372600000X

Practice address

153 Brambury Dr Apt D
Rochester, NY 14621-1820

Phone

(404) 621-2852

NPI assigned

Jul 6, 2019

Last updated

Jul 6, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1562371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562371200000",
    "number": "1467014894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64283",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146246683",
            "telephone_number": "404-321-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 BRAMBURY DR APT D",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146211820",
            "telephone_number": "404-621-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRYSTAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-06",
        "last_updated": "2019-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "NY",
            "license": "NYGA0401903R",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashton B Clark
• Bryanna Clark, MS, LMHC
• Carol Clark
• Catherine Celeste Clark, M.S., CCC-A
• Chaynna Clark, LMHC
• Danielle Clark, NP
• Deborah Clark, RN
• Emily Clark, DO
• Gregory D Clark, PT
• Gregory T Clark, RPH, BCOP

• Adult Companion in Rochester, NY
• Providers in Rochester, NY by specialty
• Adult Companion in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2019; 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.