Ann Elizabeth Blankenship Clark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-03932 Issued in NC

Practice address

1031 W Williams St
Apex, NC 27502-3955

Phone

(919) 363-0190

NPI assigned

Dec 31, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: ann.clark@1043696271228932.direct.elationemr.com

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

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356912000000",
    "number": "1538405154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 RIDGEFIELD DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275178661",
            "telephone_number": "704-293-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 W WILLIAMS ST",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275023955",
            "telephone_number": "919-363-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENSHIP CLARK",
        "first_name": "ANN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-31",
        "last_updated": "2012-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L003116",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Apex, NC
• Providers in Apex, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; 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.