Active NPI
Paulette Clark
- Registered Nurse
- Freeport, NY
National Provider Identifier
1497250765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 618320
- Practice address
- 293 N Long Beach Ave
Freeport, NY 11520-1506 - Phone
- (516) 305-2661
- NPI assigned
- Mar 28, 2018
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 618320 | NM | Primary |
Addresses
Primary practice location
293 N Long Beach Ave
Freeport, NY 11520-1506
Mailing address
293 N Long Beach Ave
Freeport, NY 11520-1506
Phone (516) 305-2661
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 618320 | NM | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522195200000",
"number": "1497250765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "293 N LONG BEACH AVE",
"city": "FREEPORT",
"state": "NY",
"postal_code": "115201506",
"telephone_number": "516-305-2661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "293 N LONG BEACH AVE",
"city": "FREEPORT",
"state": "NY",
"postal_code": "115201506",
"telephone_number": "516-305-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "PAULETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-28",
"last_updated": "2018-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NM",
"license": "618320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freeport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.