Dennis Wayne Clark, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

1-097193 Issued in AL

Practice address

1757 Imperial Blvd.
Lake Charles, LA 70605

Phone

(337) 310-2832

NPI assigned

Jun 27, 2006

Last updated

Aug 16, 2010By the provider in NPPES

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Abbeville General Hospital

  dba Abbeville Anesthesia

  • Anesthesiology Physician
  • Abbeville, LA
  • NPI 1780616094

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Lake Charles Anesthesiology, Apmc

  • Anesthesiology Physician
  • Lake Charles, LA
  • NPI 1588674790
  Medicare reassignment NPD
• Melanie C. Firmin, MD Apmc

  • Interventional Pain Medicine Physician
  • Alexandria, LA
  • NPI 1760598726
  NPD (past)
• Surgical Anesthesia Services of California

  • Anesthesiology Physician
  • Davis, CA
  • NPI 1588831531
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281916800000",
    "number": "1710914486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13523 BARRETT PARKWAY DRIVE",
            "address_2": "SUITE 104",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630213802",
            "telephone_number": "636-936-6868",
            "fax_number": "636-938-1486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1757 IMPERIAL BLVD.",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70605",
            "telephone_number": "337-310-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DENNIS",
        "middle_name": "WAYNE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2010-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-097193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051511198",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03429236",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51511198",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Seale Churchman, DDS
• Sloane Elizabeth Churchman, MS, RD, LDN
• Cathy Marie Clanton, COUNSELOR IN TRAININ
• Clark a Gunderson MD AMC
• Courtney Clark, APRN, FNP-C
• Germaine Marie Clark
• Keidra Clark, MSN, RN
• Lakeisha Clark
• Michael Dwayne Clark
• Rebecca Theresa Clark, RN

• Certified Registered Nurse Anesthetist in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Certified Registered Nurse Anesthetist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.