Active NPI
Kim Michele Clark, RN
- Registered Nurse
- Corvallis, OR
National Provider Identifier
1760638290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 095006090RN
- Practice address
- 6820 NW Grandview Dr
Corvallis, OR 97330-2706 - Phone
- (541) 753-0708
- NPI assigned
- Aug 15, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 095006090RN | OR | Primary |
| Community Health Worker | 172V00000X |
Addresses
Primary practice location
6820 NW Grandview Dr
Corvallis, OR 97330-2706
Mailing address
6820 NW Grandview Dr
Corvallis, OR 97330-2706
Phone (541) 753-0708
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 095006090RN | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1760638290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6820 NW GRANDVIEW DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973302706",
"telephone_number": "541-753-0708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6820 NW GRANDVIEW DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973302706",
"telephone_number": "541-753-0708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KIM",
"middle_name": "MICHELE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-15",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "095006090RN",
"primary": true
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.