Gabriela Clark, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN294112 Issued in GA

Practice address

11050 Crabapple Road
BLDG. a, Suite 104-B
Roswell, GA 30075

Phone

(770) 645-0017

Fax

(770) 645-0224

NPI assigned

Sep 21, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3619/brand/1/csg/1/fhir/r4
• Direct secure messaging: gabriela.clark.1@3619.direct.athenahealth.com

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.

• North Roswell Internal Medicine, PC

  • Internal Medicine Physician
  • Roswell, GA
  • NPI 1952580177
  Medicare reassignment NPD

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1750169504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 CRABAPPLE ROAD",
            "address_2": "BLDG. A, SUITE 104-B",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30075",
            "telephone_number": "770-645-0017",
            "fax_number": "770-645-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 CRABAPPLE ROAD",
            "address_2": "BLDG. A, SUITE 104-B",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30075",
            "telephone_number": "770-645-0017",
            "fax_number": "770-645-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GABRIELA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-21",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN294112",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN294112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA BOARD OF NURSING",
            "identifier": "RN294112",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter Cicinelli
• George Bennett Cierny, M.D
• Circulatory Centers Georgia, P.C.
• April S Clark, MS, LAT, ATC
• Elizabeth Clark
• Gerald H. Clark, M.D.
• Hannah Clark
• Madison Clark
• Stephanie Clark, LMFT, LPC
• Suzanne Clark, LPC

• Family Nurse Practitioner in Roswell, GA
• Providers in Roswell, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.