Rebecca Clark, MS, PA-C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

PA02134 Issued in TX

Practice address

6565 West Loop S
Suite 800
Bellaire, TX 77401-3500

Phone

(713) 661-4383

Fax

(713) 661-4346

NPI assigned

May 7, 2007

Last updated

Jan 2, 2008By 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 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

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.

• Kelsey-Seybold Medical Group, PLLC

  dba Kelsey Seybold Clinic

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1013915255

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199232000000",
    "number": "1578776571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 WEST LOOP S",
            "address_2": "SUITE 800",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "774013500",
            "telephone_number": "713-661-4383",
            "fax_number": "713-661-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6565 WEST LOOP S",
            "address_2": "SUITE 800",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "774013500",
            "telephone_number": "713-661-4383",
            "fax_number": "713-661-4346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "REBECCA",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2008-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "PA02134",
            "primary": true
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "TX",
            "license": "PA02134",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "TX",
            "license": "PA02134",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TX",
            "license": "PA02134",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana W Chudej, DDS
• Nicholas Chulski, CNIM
• John Christopher Cianca, M.D.
• City of Bellaire
• James L. Claghorn, M.D
• Renee M. Clary, PA-C
• Claudia Orengo, MD, PHD, PA
• Karen Clemente, D.D.S., M.S.
• Courtney Clutter, M.D.
• Kristin Leigh Cogan, LPC

• Dermatology Physician in Bellaire, TX
• Providers in Bellaire, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; 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.