Stacey Ellen Clark, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5005457 Issued in NC

Practice address

414 E Main St
Durham, NC 27701-3720

Phone

(919) 560-7925

NPI assigned

Jul 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Stacey Ellen Burgin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415836800000",
    "number": "1528098712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53507 BICKETT",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275178570",
            "telephone_number": "919-560-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 E MAIN ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277013720",
            "telephone_number": "919-560-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STACEY",
        "middle_name": "ELLEN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2014-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP14812",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5005457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "BURGIN",
            "middle_name": "ELLEN",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Clark, LCSW
• Robert Earl Clark II, MD
• Shane Michael Clark, MD
• Sima Ytina Clark
• Sonia C Clark
• Tiana Clark, MA, LCMC
• Amy Clarke, PHARMD
• April Kersta Clarke
• Collin Franklin Murphy Clarke, M.D
• Eboni Tashlin Clarke, LCSW, LMSW

• Family Nurse Practitioner in Durham, NC
• Providers in Durham, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; 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.