Phillip Wayne Clark, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP 7468 Issued in AZ

Practice address

11560 Olive Blvd
Creve Coeur, MO 63141-7111

Phone

(314) 995-7128

Fax

(314) 995-7221

NPI assigned

Oct 7, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1023174455
  Medicare reassignment NPD
• Missouri HB Medical Services, LLC

  • Emergency Medicine Physician
  • Poplar Bluff, MO
  • NPI 1922868462
  Medicare reassignment
• Prescott Healthcare Solutions LLC

  • Family Medicine Physician
  • Prescott, AZ
  • NPI 1821454505
  Medicare reassignment
• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1609939214
  NPD

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1629471412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11560 OLIVE BLVD",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417111",
            "telephone_number": "314-995-7128",
            "fax_number": "314-995-7221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11560 OLIVE BLVD",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417111",
            "telephone_number": "314-995-7128",
            "fax_number": "314-995-7221"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 N Stockton Hill Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "864014140",
            "country_code": "US",
            "telephone_number": "928-255-5050",
            "fax_number": "888-571-5897",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 E. Tyson Rd",
            "address_purpose": "LOCATION",
            "city": "Quartzsite",
            "state": "AZ",
            "postal_code": "853594618",
            "country_code": "US",
            "telephone_number": "928-927-8749",
            "fax_number": "928-927-8748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3100 Oak Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639011573",
            "country_code": "US",
            "telephone_number": "573-776-9290",
            "fax_number": "659-235-6176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PHILLIP",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-07",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP 7468",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP-02553",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2014034806",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Childrens Endocrine Care of St. Louis, LLC
• Chiropractic Care & Sports Rehab, Inc.
• Audrey Nicole Christen, BCBA
• Cassadi Christenson, LCP
• Joan Chusak, R.PH.
• Clarkson Optometry Inc
• Clear Practice PLLC
• Betsy F. Clemens, M.D.
• Ethan D Cobbel
• Keara Cobbs, PMHNP

• Family Nurse Practitioner in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.