NPIMap

Individual provider Active NPI

Nichole Deann Clark, FNP

  • Family Nurse Practitioner
  • Clinton, AR
National Provider Identifier
1548464936
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A01919 Issued in AR
Practice address
145 Shakerag Road
Clinton, AR 72031-6657
Phone
(501) 745-7161
Fax
(501) 745-8714
NPI assigned
Jun 12, 2007
Last updated
Nov 4, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A01919 AR Primary

Addresses

Primary practice location

145 Shakerag Road
Clinton, AR 72031-6657

Mailing address

PO Box 1333
Clinton, AR 72031
Phone (501) 745-7161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100219000050 AR Practitioner - Nurse Practitioner 5597797506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Vanderbilt University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hope Medical Clinic IncGroup PAC ID 9739223462, 4 clinicians

Practice addresses (Care Compare)

145 Shake Rag Rd
Clinton, AR 72031-6682
Phone (501) 858-4488

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A01919ARMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hope Medical Clinic Inc CurrentSince Dec 28, 2009 Accepting new patients
Physicians Medical Group PLC CurrentSince Jan 4, 2010 Accepting new patients
Caps Medical Management LLC Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

145 Shake Rag Rd
Clinton, AR 72031
Phone (501) 745-7161

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hope Medical Clinic IncClinton, AR, CCN 043832 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Director
W-2 Managing Employee		 Nov 13, 2009
Jul 1, 2010
Jul 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1548464936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1333",
            "city": "CLINTON",
            "state": "AR",
            "postal_code": "72031",
            "telephone_number": "501-745-7161",
            "fax_number": "501-745-8714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 SHAKERAG ROAD",
            "city": "CLINTON",
            "state": "AR",
            "postal_code": "720316657",
            "telephone_number": "501-745-7161",
            "fax_number": "501-745-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICHOLE",
        "middle_name": "DEANN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A01919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, AR

Sources for this page

Verify at the official NPI Registry.