Active NPI
Leslie Mason Clark, R.D., L.D.
- Registered Dietitian
- Henderson, KY
National Provider Identifier
1467752436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2278
- Practice address
- 472 Klutey Park Plaza Dr
Henderson, KY 42420-3348 - Phone
- (270) 826-3951
- NPI assigned
- Oct 25, 2010
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2278 | KY | Primary |
Addresses
Primary practice location
472 Klutey Park Plaza Dr
Henderson, KY 42420-3348
Mailing address
1501 Breckenridge St
Owensboro, KY 42303-1054
Phone (270) 686-7747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2278 | KY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287964800000",
"number": "1467752436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 BRECKENRIDGE ST",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "423031054",
"telephone_number": "270-686-7747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "472 KLUTEY PARK PLAZA DR",
"city": "HENDERSON",
"state": "KY",
"postal_code": "424203348",
"telephone_number": "270-826-3951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LESLIE",
"middle_name": "MASON",
"name_prefix": "Mrs.",
"credential": "R.D., L.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-25",
"last_updated": "2010-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "KY",
"license": "2278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.