Active NPI
Kenneth Dale Clark
- Orthotist
- The Woodlands, TX
National Provider Identifier
1598046401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- 400
- Practice address
- 9303 Pinecroft Dr
The Woodlands, TX 77380-3181 - Phone
- (281) 297-6445
- Fax
- (281) 297-6460
- NPI assigned
- Sep 6, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthotist | 222Z00000X | 400 | TX | Primary |
Addresses
Primary practice location
9303 Pinecroft Dr
The Woodlands, TX 77380-3181
Mailing address
9303 Pinecroft Dr
The Woodlands, TX 77380-3181
Phone (281) 297-6445
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 094010801 | Other | TX | GROUP MEDICAID NUMBER |
| 00J21A | Other | TX | GROUP MEDICARE NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 400 | TX | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317081600000",
"number": "1598046401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9303 PINECROFT DR",
"city": "THE WOODLANDS",
"state": "TX",
"postal_code": "773803181",
"telephone_number": "281-297-6445",
"fax_number": "281-297-6460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9303 PINECROFT DR",
"city": "THE WOODLANDS",
"state": "TX",
"postal_code": "773803181",
"telephone_number": "281-297-6445",
"fax_number": "281-297-6460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KENNETH",
"middle_name": "DALE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-06",
"last_updated": "2011-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "TX",
"license": "400",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICAID NUMBER",
"identifier": "094010801",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE NUMBER",
"identifier": "00J21A",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in The Woodlands, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.