Active NPI
Patricia Michelle Clark, D.O.
- Family Medicine Physician
- Montgomery, WV
National Provider Identifier
1679735930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2407
- Practice address
- 401 6TH Ave
Montgomery, WV 25136-2116 - Phone
- (304) 442-2521
- Fax
- (304) 442-7463
- NPI assigned
- Jun 27, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2407 | WV | Primary |
Addresses
Primary practice location
401 6TH Ave
Montgomery, WV 25136-2116
Mailing address
401 6TH Ave
Montgomery, WV 25136-2116
Phone (304) 442-2521
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2407 | WV | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320364800000",
"number": "1679735930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 6TH AVE",
"city": "MONTGOMERY",
"state": "WV",
"postal_code": "251362116",
"telephone_number": "304-442-2521",
"fax_number": "304-442-7463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 6TH AVE",
"city": "MONTGOMERY",
"state": "WV",
"postal_code": "251362116",
"telephone_number": "304-442-2521",
"fax_number": "304-442-7463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "PATRICIA",
"middle_name": "MICHELLE",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-27",
"last_updated": "2011-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "2407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.