Myra Leslie Clark, PHD, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024170893 Issued in VA

Practice address

7048 Mechanicsville Tpke
Mechanicsville, VA 23111-7101

Phone

(804) 730-9498

Fax

(804) 569-7967

NPI assigned

Sep 23, 2008

Last updated

Oct 11, 2013By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381449600000",
    "number": "1629228093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2485 RANSON CT",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229118622",
            "telephone_number": "434-293-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7048 MECHANICSVILLE TPKE",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231117101",
            "telephone_number": "804-730-9498",
            "fax_number": "804-569-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MYRA",
        "middle_name": "LESLIE",
        "credential": "PHD, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-23",
        "last_updated": "2013-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024170893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Chuquin
• Brittany F. Church, PT
• Robin Church
• William P. Ciesla Jr., M.D.
• Clarion Hearing Systems, LLC (Hearing Aid Centers of Richmond)
• Talia Denay Clark, PA-C
• Angela Clarke
• Jessica L Clary, LCSW
• Richard M Clary, MD
• Cleanslate Medical Group of Virginia, LLC

• Family Nurse Practitioner in Mechanicsville, VA
• Providers in Mechanicsville, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; 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.