Kaulette Clark

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP127823 Issued in TX

Practice address

9900 Bren Rd E
Minnetonka, MN 55343-9664

Phone

(952) 936-1300

NPI assigned

May 14, 2015

Last updated

Jul 20, 2020By the provider in NPPES

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

Other names 1

• Kaulette Clark Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chase Dennis Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Santa Rosa, CA
  • NPI 1033152350
  NPD

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1487032132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3568 LINK VALLEY DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770255102",
            "telephone_number": "713-435-9338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 BREN RD E",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439664",
            "telephone_number": "952-936-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3568 Link Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770255102",
            "country_code": "US",
            "telephone_number": "713-435-9338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAULETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-14",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP127823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAULETTE",
            "last_name": "CLARK",
            "credential": "NP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Citadel Salida Woods LLC
• Citadel South Woods LLC
• Citadel Southwest Commons LLC
• Angela M Clapp, FNP-BC
• Diane Maxine Clark, PT
• Pontris Sapp Clark, NURSE PRACTITIONER
• Steven Allen Clark, MD
• Jazmin Clausen-Thomas
• Kendall Marie Clausen
• Monica Clayton

• Family Nurse Practitioner in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.