Active NPI
Dorthy Carlene Clark, RN
- Emergency Registered Nurse
- Poplar Bluff, MO
National Provider Identifier
1508698184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Registered Nurse
- License
- 608800
- Practice address
- 3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573 - Phone
- (573) 776-9290
- NPI assigned
- Aug 14, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 608800 | TX | Primary |
Addresses
Primary practice location
3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Mailing address
1356 County Road 3925
Mount Pleasant, TX 75455
Phone (903) 563-8089
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 608800 | TX | MD | Emergency Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1508698184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1356 COUNTY ROAD 3925",
"city": "MOUNT PLEASANT",
"state": "TX",
"postal_code": "75455",
"telephone_number": "903-563-8089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 OAK GROVE RD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639011573",
"telephone_number": "573-776-9290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DORTHY",
"middle_name": "CARLENE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-14",
"last_updated": "2024-08-14",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "163WE0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Emergency",
"state": "TX",
"license": "608800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.