Active NPI
Patricia Ann Clark, R.N.
- Registered Nurse
- Trevose, PA
National Provider Identifier
1639426109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN239726L
- Practice address
- 2500 Neshaminy Interplex Dr
Trevose, PA 19053-6943 - Phone
- (267) 991-7658
- Fax
- (267) 997-7619
- NPI assigned
- Aug 14, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN239726L | PA | Primary |
Addresses
Primary practice location
2500 Neshaminy Interplex Dr
Trevose, PA 19053-6943
Mailing address
2500 Neshaminy Interplex Dr
Trevose, PA 19053-6943
Phone (267) 991-7658
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN239726L | PA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life St. Mary | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- PACE Provider Organization
- Trevose, PA
- NPI 1003052820
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344902400000",
"number": "1639426109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 NESHAMINY INTERPLEX DR",
"city": "TREVOSE",
"state": "PA",
"postal_code": "190536943",
"telephone_number": "267-991-7658",
"fax_number": "267-997-7619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 NESHAMINY INTERPLEX DR",
"city": "TREVOSE",
"state": "PA",
"postal_code": "190536943",
"telephone_number": "267-991-7658",
"fax_number": "267-997-7619"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "PATRICIA",
"middle_name": "ANN",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-14",
"last_updated": "2012-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "PA",
"license": "RN239726L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trevose, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.