Shannon Joan Clark, AGNP RN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5006374 Issued in NC

Practice address

3700 Barrett Dr Ste 200
Raleigh, NC 27609-7172

Phone

(919) 231-3966

Fax

(919) 231-3912

NPI assigned

Aug 12, 2013

Last updated

Feb 12, 2025By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Carolina Nephrology PAGroup PAC ID 0244511483, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rex Hospital Hospital, Raleigh, NC, CCN 340114

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sclark24299@direct.acumenmd.com

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.

• North Carolina Nephrology PA

  • Nephrology Physician
  • Raleigh, NC
  • NPI 1750835336
  Medicare reassignment Care Compare group NPD
• North Carolina Nephrology PA

  • Nephrology Physician
  • Cary, NC
  • NPI 1811492663
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Rex Hospital Inc.

  dba Rex Hospital

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1497797088
  Care Compare affiliation

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1508299777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 BARRETT DR STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097172",
            "telephone_number": "919-231-3966",
            "fax_number": "919-231-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 BARRETT DR STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097172",
            "telephone_number": "919-231-3966",
            "fax_number": "919-231-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNON",
        "middle_name": "JOAN",
        "name_prefix": "Ms.",
        "credential": "AGNP RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5006374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ncnephrologyassociates@directaddress.net",
            "affiliation": "N",
            "address_1": "3700 Barrett Dr Ste 200",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276097172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Clark, DACM
• Nakima Kinte Clark
• Porter Grace Clark, PA-C
• Rebecca Clark, LCMHCA
• Sandra Hewitt Clark, M.D.
• Sharon Clark
• Sheryl Anne Clark, LPC-A, LCAS-A
• Trenita Clark, PHARMD
• Amie Lyons Clarke, P.A.-C
• Danilton Glenn Clarke, PT, DPT, CSCS

• Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.