Active NPI
Kenyatta Cleark, RPH, PHARMD
- Pharmacist
- Brentwood, TN
National Provider Identifier
1477172906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.024198
- Practice address
- 1522 Moores CT
Brentwood, TN 37027-2923 - Phone
- (769) 251-3601
- NPI assigned
- Apr 14, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | PST.024198 | LA | Primary |
Addresses
Primary practice location
1522 Moores CT
Brentwood, TN 37027-2923
Mailing address
1522 Moores CT
Brentwood, TN 37027-2923
Phone (769) 251-3601
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.024198 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664496000000",
"number": "1477172906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1522 MOORES CT",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370272923",
"telephone_number": "769-251-3601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1522 MOORES CT",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370272923",
"telephone_number": "769-251-3601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEARK",
"first_name": "KENYATTA",
"name_prefix": "Dr.",
"credential": "RPH, PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-14",
"last_updated": "2022-09-30",
"certification_date": "2022-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.024198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.