Shelley B Clark, LPTA
Individual provider Active NPI Skilled Nursing Facility · Ocean Springs, MS
NPI 1689066367 · NPPES record last updated Mar 4, 2015
Key facts
- NPI
- 1689066367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- PTA4100 (MS)
- Practice address
- 6520 Sunscope Dr
Ocean Springs, MS 39564-8690 - Phone
- (228) 875-1177
- Fax
- (228) 872-4009
- NPI assigned
- Mar 4, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA4100 | MS | MD | Skilled Nursing Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | PTA4100 | MS | Yes |
Addresses
Primary practice location
6520 Sunscope Dr
Ocean Springs, MS 39564-8690
Mailing address
6520 Sunscope Dr
Ocean Springs, MS 39564-8690
Phone (228) 875-1177
Other providers in Ocean Springs, MS
- Christopher Cheng
- Children'S Clinic of Ocean Springs
- Michael J Christie
- Karmen Renee Clark
- Mallory Clark
- Lana Leigh Clayton
- CLC of Ocean Springs, LLC
- Jennifer Adriana Clement
- Coast Dermatopathology Group
- Coast Kidney Disease & Internal Medicine
All providers in Ocean Springs, MS · Skilled Nursing Facility in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.