Kateryna Vadimovna Clark, M.S., R.D

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI952 Issued in ME

Practice address

135 Grove St
Bangor, ME 04401-4007

Phone

(207) 299-4940

NPI assigned

Sep 22, 2011

Last updated

Sep 22, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1508149964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 GROVE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014007",
            "telephone_number": "207-299-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 GROVE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014007",
            "telephone_number": "207-299-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATERYNA",
        "middle_name": "VADIMOVNA",
        "name_prefix": "Ms.",
        "credential": "M.S., R.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ME",
            "license": "DI952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Bangor (Bangor Health & Community Services)
• City of Bangor (Bangor Fire Department)
• City of Bangor
• Charles A Civiello Jr., O.D.
• Georgia Clark-Albert, MS RD LD CDE
• Peggy D Clark, SLP
• Tracey Durkovich Clark, DO
• James Lincoln Clarke, M.D.
• Classic Dentures of Maine
• Nile Clem

• Registered Dietitian in Bangor, ME
• Providers in Bangor, ME by specialty
• Registered Dietitian in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.