Kanchan Puri Clark, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

VA0101057674 Issued in VA

Practice address

382 Taylor Dr
Danville, VA 24541

Phone

(434) 773-4240

Fax

(434) 773-4241

NPI assigned

Mar 24, 2006

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

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prince William County Community Services BoardGroup PAC ID 7113912973, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Prince William County Community Services Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manassas, VA
  • NPI 1053402800
  Medicare reassignment Care Compare group NPD
• Commonwealth of Virginia Department of Behavioral Health and Southern

  • Hospitalist Physician
  • Danville, VA
  • NPI 1386704898
  Medicare reassignment NPD
• Prince William County

  • Ambulance
  • Prince William, VA
  • NPI 1235437385
  NPD

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1649230509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 TAYLOR DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "24541",
            "telephone_number": "434-773-4240",
            "fax_number": "434-773-4241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 TAYLOR DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "24541",
            "telephone_number": "434-773-4240",
            "fax_number": "434-773-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KANCHAN",
        "middle_name": "PURI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "VA0101057674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mykala Denise Clardy
• Christy Marie Clark, AGACNP-BC
• Donovan Deryl Clark, MD
• Jada Nyiesha Clark
• Jessica Clark
• Nancy Coppic Clark, O.D.
• Tiffany Devon Clark
• Ronald Clarke Jr., LSATP
• Clearview Rehabilitation Services, LLC
• Nathaniel A Cleaveland, D.O.

• Psychiatry Physician in Danville, VA
• Providers in Danville, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.