Clyde Dodson Paulk, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C3204 Issued in AR

Practice address

21 Opportunity Dr
Sheridan, AR 72150-9185

Phone

(870) 942-9833

Fax

(870) 942-9837

NPI assigned

Mar 15, 2006

Last updated

Jun 30, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Arkansas Health Group

  dba Paulk Family Clinic/A Baptist Health Affiliate

  • Family Medicine Physician
  • Sheridan, AR
  • NPI 1548239247
  NPD (past) Authorized official

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246320000000",
    "number": "1497724157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 OPPORTUNITY DR",
            "city": "SHERIDAN",
            "state": "AR",
            "postal_code": "721509185",
            "telephone_number": "870-942-9833",
            "fax_number": "870-942-9837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 OPPORTUNITY DR",
            "city": "SHERIDAN",
            "state": "AR",
            "postal_code": "721509185",
            "telephone_number": "870-942-9833",
            "fax_number": "870-942-9837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULK",
        "first_name": "CLYDE",
        "middle_name": "DODSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2009-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C3204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BREASTCARE",
            "identifier": "770023201",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "01020368",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4295730",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEATLHLINK",
            "identifier": "383494",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102505001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "14003000000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Alvin Nichols, RN, MSN,BSN
• P C Well, PA (Power Chiropractic 3)
• Paul D Fitzgerald, DDS
• Paul D Fitzgerald, DDS
• Paula Ross, LLC
• Clara R Penney, MS, LPEI
• Kaci Pettit, QBHP
• Ashley Nicole Pierce, LMSW
• Pope Family Medical Clinic, PLLC
• Tammy K Pope, MD

• Family Medicine Physician in Sheridan, AR
• Providers in Sheridan, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; 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.