Active NPI
Carole A Clark, ARNP
- Nurse Practitioner
- Marysville, WA
National Provider Identifier
1710056882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AP30003020
- Practice address
- 4420 76TH St NE
Marysville, WA 98270-3726 - Phone
- (360) 339-5492
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP30003020 | WA | Primary |
Addresses
Primary practice location
4420 76TH St NE
Marysville, WA 98270-3726
Mailing address
PO Box 5127
Everett, WA 98206-5127
Phone (425) 258-3900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AP30003020 | Other | WA | LICENSE |
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 |
|---|---|---|---|
| AP30003020 | WA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577750400000",
"number": "1710056882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5127",
"city": "EVERETT",
"state": "WA",
"postal_code": "982065127",
"telephone_number": "425-258-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4420 76TH ST NE",
"city": "MARYSVILLE",
"state": "WA",
"postal_code": "982703726",
"telephone_number": "360-339-5492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CAROLE",
"middle_name": "A",
"credential": "ARNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2019-12-31",
"certification_date": "2019-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP30003020",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "AP30003020",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marysville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.