Individual provider Active NPI

Sally Lee Clark, NP

  • Family Nurse Practitioner
  • Maryville, TN
National Provider Identifier
1699540435
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
33133 Issued in TN
Practice address
907 E Lamar Alexander Pkwy
Maryville, TN 37804-5015
Phone
(865) 977-4618
NPI assigned
Nov 21, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 33133 TN Primary

Addresses

Primary practice location

907 E Lamar Alexander Pkwy
Maryville, TN 37804-5015

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842

Other identifiers 1

IdentifierTypeStateIssuer
Q088561MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240215002771 TN Practitioner - Nurse Practitioner 7214371434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blount Memorial Physician Group IncGroup PAC ID 6406844174, 252 clinicians

Practice addresses (Care Compare)

907 E Lamar Alexander Pkwy
Maryville, TN 37804-5015
Phone (865) 980-4897

Hospital & facility affiliations

  • Blount Memorial Hospital Hospital, Maryville, TN, CCN 440011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Blount Memorial Physician Group, Inc CurrentSince Feb 1, 2024 Accepting new patients

Locations

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

103 W Broadway Ave
Maryville, TN 37801

907 Lamar Alexander Pkwy
Maryville, TN 37804
Phone (865) 766-8818

463 Bmh Physicians Office Bldg
Maryville, TN 37804
Phone (865) 980-5100

Interoperability endpoints

  • Direct secure messaging: sclark864488@direct.ghs.myhfn.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1699540435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045015",
            "telephone_number": "865-977-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SALLY",
        "middle_name": "LEE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-21",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "33133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q088561",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, TN

Sources for this page

Verify at the official NPI Registry.