Deanna R Clark, CFNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP-03049 Issued in NM

Practice address

4225 Montgomery Blvd NE
Albuquerque, NM 87109-1103

Phone

(505) 366-3635

Fax

(505) 221-5429

NPI assigned

Oct 4, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Albuquerque Urgent Care Walk in Clinic PCGroup PAC ID 4880953165, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Albuquerque Urgent Care Walk in Clinic PC

  • Urgent Care Clinic/Center
  • Albuquerque, NM
  • NPI 1487167961
  Medicare reassignment Care Compare group NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  NM

  Medicare reassignment NPD
• Small Town Family Practice LLC

  • Primary Care Clinic/Center
  • Albuquerque, NM
  • NPI 1164194940

  Family

  NPD Authorized official

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1477003366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091103",
            "telephone_number": "505-366-3635",
            "fax_number": "505-221-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091103",
            "telephone_number": "505-366-3635",
            "fax_number": "505-221-5429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEANNA",
        "middle_name": "R",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-04",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP-03049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Anne Clark, M.S.
• Cate A Clark, LMT
• Chantel C Clark, MD
• Cora Clark
• Dacy Jael Clark, PT, DPT
• Derek Clark, BOCO C.PED
• Devon Tierney Clark, MD
• Donald Wayne Clark, MD
• Douglas A. Clark, MD
• Douglas Paul Clark, M.D.

• Family Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.
• 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.

Verify at the official NPI Registry.