Debra Doublet Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA163 Issued in AR

Practice address

1609 W 40TH Ave
Suite 501
Pine Bluff, AR 71603-6329

Phone

(870) 534-3449

Fax

(870) 535-3973

NPI assigned

Apr 21, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1649236472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 501",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3449",
            "fax_number": "870-535-3973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 501",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3449",
            "fax_number": "870-535-3973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEBRA",
        "middle_name": "DOUBLET",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raven Cherry, RN
• Children'S Clinic, P.a.
• Stephen Christian
• City 2 City Marketing & Distribution
• Charles A Clark, MD
• Derwin Clark
• Michael D Clark, DDS
• Shelby Danyelle Clements, B.A
• Johnny F Clendenin Jr., CRNA
• Clifton G Roaf & Marvin Q Caudle

• Physician Assistant in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.