Stephanie Nicole Clark

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN225891 Issued in GA

Practice address

1050 Eagles Landing Pkwy Ste 202
Stockbridge, GA 30281-9200

Phone

(678) 289-1988

Fax

(678) 289-1512

NPI assigned

Apr 18, 2020

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

Other names 1

• Stephanie Nicole Elliott Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Aylo Health, LLC

  • Family Medicine Physician
  • Locust Grove, GA
  • NPI 1710929914
  NPD (past)
• Aylo Health, LLC

  • Sleep Medicine (Family Medicine) Physician
  • Stockbridge, GA
  • NPI 1922831445
  NPD (past)
• Covenant Care Pediatrics PC

  • Pediatrics Physician
  • Stockbridge, GA
  • NPI 1902941503
  NPD (past)

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

{
    "created_epoch": "1587168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1760002893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 EAGLES LANDING PKWY STE 202",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819200",
            "telephone_number": "678-289-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 EAGLES LANDING PKWY STE 202",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819200",
            "telephone_number": "678-289-1988",
            "fax_number": "678-289-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHANIE",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-18",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN225891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "ELLIOTT",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• City EMS
• CJ Pediatrics LLC
• Dorian Claggett
• Clark & Clark Counseling Center, LLC
• Jeanine Clark, FNP
• Susan Marie Clark, PH.D
• Shanique Clarke
• Rashonda L Clay-Douthit, LCSW
• Clayton Orthopedic Clinic
• Araylyn Clements King

• Family Nurse Practitioner in Stockbridge, GA
• Providers in Stockbridge, 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 8, 2021; 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.