Kristie Dawn Clark, PHARMD, CDE

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

0070-00413 Issued in NC

Practice address

10816 Black Dog LN Ste 160
Charlotte, NC 28214-1479

Phone

(704) 316-3970

Fax

(704) 316-3971

NPI assigned

Jul 24, 2012

Last updated

Jan 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Doctor of Pharmacy

State licenses

Interoperability endpoints

• Direct secure messaging: kclark1069988@direct.novanthealth.org

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1619222932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10816 BLACK DOG LN STE 160",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282141479",
            "telephone_number": "704-316-3970",
            "fax_number": "704-316-3971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Medical Park Dr",
            "address_2": "Ste 550",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252982",
            "country_code": "US",
            "telephone_number": "704-403-1307",
            "fax_number": "704-403-3655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRISTIE",
        "middle_name": "DAWN",
        "credential": "PHARMD, CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-24",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NC",
            "license": "17299",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NC",
            "license": "0070-00413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily A Clark, SLP
• Herman Clark, LCAS-A
• Jason Drew Clark, D.D.S.
• John B Clark Jr., M.D.
• Kortney Wilson Clark, FNP
• Laura L Clark, MS, LCAS
• Lawrence Clark, LCMHC, LCASA, LPC
• Lisa R Clark, PT
• Luke Samuel Clark, PA-C
• Lyndsay Clark, PA

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.