Carol Clark, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71000959A Issued in IN

Practice address

9015 E 17TH St
Indianapolis, IN 46229-2016

Phone

(317) 898-3166

Fax

(317) 898-4219

NPI assigned

May 17, 2006

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Riggs Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Lafayette, IN
  • NPI 1386660900
  NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• Meridian Health Services Corp

  • Rural Health Clinic/Center
  • Rushville, IN
  • NPI 1477504181
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335916800000",
    "number": "1770535502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9015 E 17TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292016",
            "telephone_number": "317-898-3166",
            "fax_number": "317-898-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9015 E 17TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292016",
            "telephone_number": "317-898-3166",
            "fax_number": "317-898-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAROL",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "IN",
            "license": "71000959A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71000959A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200307710",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "P01016729",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Clark, NP
• Brenda Belden Clark, PHARMD
• Brendon Matthew Clark
• Brittney Le'Shai Clark
• Cameron Clark, RBT
• Charles Malcolm Clark Jr., MD
• Cherie Clark, M.A.
• Cordell L Clark
• David Clark
• David Glenn Clark, MD

• Family Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; 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.