Kourtney Leciera Clark

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

2728 Euclid Ave
Cleveland, OH 44115-2429

Phone

(216) 600-5194

NPI assigned

Mar 14, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• YMCA

  • Case Management Agency
  • Columbus, OH
  • NPI 1790236933
  NPD
• Young Men'S Christian Association of Central Ohio

  • Case Management Agency
  • Columbus, OH
  • NPI 1326593302
  NPD

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

{
    "created_epoch": "1584144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584144000000",
    "number": "1467088070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 SUMMERFERN LN",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432137642",
            "telephone_number": "216-333-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2728 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441152429",
            "telephone_number": "216-600-5194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KOURTNEY",
        "middle_name": "LECIERA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-14",
        "last_updated": "2020-03-14",
        "certification_date": "2020-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Clark
• Joseph D Clark
• Juliette Clark, DMD
• Kayla Clark
• Kinya Clark, LPN
• Krystal Clark
• Larry Clark
• Lisa Marie Clark, CAA
• Lorene Clark
• Marnise Dannette Clark, LPN

• Case Manager/Care Coordinator in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Case Manager/Care Coordinator in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2020; 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.