Mar Keshia Clarke, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

15097 Issued in CA

Practice address

12618 Hawthorne Blvd
Hawthorne, CA 90250-3907

Phone

(310) 263-5700

NPI assigned

Feb 6, 2007

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

University of California, Geffen School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mclarke2893750@oc.providencedirect.org

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.

• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1417915760
  Medicare reassignment Care Compare group NPD
• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569
  NPD
• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1760425862
  NPD

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1730228388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21311 MADRONA AVE STE 101",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905035970",
            "telephone_number": "866-909-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12618 HAWTHORNE BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902503907",
            "telephone_number": "310-263-5700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "742 W Gardena Blvd",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902475024",
            "country_code": "US",
            "telephone_number": "310-802-6177",
            "fax_number": "310-802-6178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "MAR KESHIA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "15097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Citycare Homehealth Provider Inc
• Kimberly Michonne Clark-Holloway
• Brandt Clark, PT
• Kayla Clark
• Christal Clarke
• Moises A Claudio-Henriquez
• Aaron Clothier, P.A.
• Andrea T Clow, L.AC, LMT
• Coastal Communication Center
• Monica Lorene Cody, MA, CADC-II

• Nurse Practitioner in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.