Katie Lenore Clancy, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704288350 Issued in MI

Practice address

4350 Dixie Hwy
Waterford, MI 48329-3506

Phone

(248) 674-0466

NPI assigned

May 11, 2021

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)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Perry Drug Stores Inc and Subsidiaries

  dba Rite Aid Pharmacy 04487

  • Community/Retail Pharmacy
  • Commerce Township, MI
  • NPI 1871602391
  NPD (past)
• Perry Drug Stores Inc and Subsidiaries

  dba Rite Aid Pharmacy 04476

  • Community/Retail Pharmacy
  • Waterford, MI
  • NPI 1992717698
  NPD (past)

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1689258949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6467 WILSON DR",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293176",
            "telephone_number": "248-722-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 DIXIE HWY",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293506",
            "telephone_number": "248-674-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "KATIE",
        "middle_name": "LENORE",
        "name_prefix": "Miss",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704288350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hyden Myung Il Choi, DDS
• Chufi Afc Inc
• Circle of Life Home Care LLC
• Jacqueline Ann Cisternino, CPSS
• Brandi Claerhout
• Clarity Eye Contact, PLLC (Eye Contact Vision Center)
• Davita Clark
• Kelly Ann Clark, BCBA
• Lindsay Marie-Portrey Clark
• Clear Star Wellness and Staffing LLC

• Registered Nurse in Waterford, MI
• Providers in Waterford, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; 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.