Active NPI
Chelsea Clark
- Family Nurse Practitioner
- Summerville, SC
National Provider Identifier
1700500014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 27234
- Practice address
- 1452 Boone Hill Rd
Summerville, SC 29483-2408 - Phone
- (843) 509-4415
- NPI assigned
- Sep 29, 2022
- 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 Nurse Practitioner | 363LF0000X | 27234 | SC | Primary |
Addresses
Primary practice location
1452 Boone Hill Rd
Summerville, SC 29483-2408
Mailing address
123 Garden Grove Dr
Summerville, SC 29485-8791
Phone (724) 996-4113
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27234 | SC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753142400000",
"number": "1700500014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 GARDEN GROVE DR",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294858791",
"telephone_number": "724-996-4113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1452 BOONE HILL RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294832408",
"telephone_number": "843-509-4415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHELSEA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-29",
"last_updated": "2025-07-22",
"certification_date": "2025-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "27234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.