Bobby Clark

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

302 Railway Ave
Seward, AK 99664-0999

Phone

(907) 224-5257

Fax

(907) 224-7081

NPI assigned

Feb 1, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1598528507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1045",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "996641045",
            "telephone_number": "907-224-5257",
            "fax_number": "907-224-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 RAILWAY AVE",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "996640999",
            "telephone_number": "907-224-5257",
            "fax_number": "907-224-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BOBBY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Seward
• City of Seward
• City of Seward
• City of Seward
• City of Seward
• Gracie Renee Cleek
• Tricia Lyn Clemons, LMT, BCTMB
• Brett Clendaniel
• Clinic at Primrose LLC
• Bryan Collins

• All providers in Seward, AK
• Community Health Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.