Mary Kathlyn Clark, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APN1171 Issued in SC

Practice address

620 C Congaree Rd
Greenville, SC 29607

Phone

(864) 254-9477

Fax

(864) 254-9896

NPI assigned

Nov 13, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Healthstat on-Site Clinic/Milliken Enterprise

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Marietta, SC
  • NPI 1386079317
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1699846436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 LICHEN DR",
            "city": "WILLIAMSTON",
            "state": "SC",
            "postal_code": "296978514",
            "telephone_number": "864-840-9128",
            "fax_number": "864-231-9468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 C CONGAREE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29607",
            "telephone_number": "864-254-9477",
            "fax_number": "864-254-9896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "518 Pumpkintown Rd",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "SC",
            "postal_code": "296619526",
            "country_code": "US",
            "telephone_number": "864-250-6169",
            "fax_number": "864-250-6222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "512 Pumpkintown Rd",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "SC",
            "postal_code": "296619526",
            "country_code": "US",
            "telephone_number": "864-250-5320",
            "fax_number": "864-250-5390",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Highway 29 S",
            "address_purpose": "LOCATION",
            "city": "Anderson",
            "state": "SC",
            "postal_code": "296263038",
            "country_code": "US",
            "telephone_number": "864-231-6000 x8909",
            "fax_number": "864-231-6498",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "290 Old Anderson Rd.",
            "address_purpose": "LOCATION",
            "city": "Pendleton",
            "state": "SC",
            "postal_code": "29670",
            "country_code": "US",
            "telephone_number": "864-646-4121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "KATHLYN",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "APN1171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0553",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Clark, PHARMD
• Lynda Laura Clark, M.S.
• Mackenzie Bagwell Clark
• Madison Clark
• Martha Jameson Clark, APRN
• Matthew Thomas Clark, M.D.
• Russell Derrick Clark, DPT
• Sara Morgan Clark, M.D.
• Susan Nock Clark, RN
• Taylor Ellis Clark, FNP-C

• Nurse Practitioner in Greenville, SC
• Providers in Greenville, SC by specialty
• Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.