Teresa Louise Clark, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

258115 Issued in CA

Practice address

2121 E 1St St
306
Long Beach, CA 90803-2418

Phone

(661) 675-5177

NPI assigned

Apr 5, 2013

Last updated

Apr 23, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Teresa Louise Clark Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1365120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1750624904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 EAST FIRST STREET #306",
            "address_2": "306",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "93551",
            "telephone_number": "661-675-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E 1ST ST",
            "address_2": "306",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908032418",
            "telephone_number": "661-675-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TERESA",
        "middle_name": "LOUISE",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-05",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "258115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED VOCATIONAL NURSE",
            "identifier": "164W",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERESA",
            "last_name": "CLARK",
            "middle_name": "LOUISE",
            "credential": "LVN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kristin Tai Clark
• Melissa Ann Clark, MCD, CCC-SLP
• Robert Alexander Clark, M.D
• Sheila Renee Clark, CATC
• Stephen W Clark, D.D.S.
• Tiffany Clark
• Tracy Ann Clark, M.D.
• Matthew E.a. Clarke, MD
• Vanessa Nicole Claros, NP
• Ashley Clary

• Licensed Vocational Nurse in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.