Courtney A Clark, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

29407 Issued in MS

Practice address

2274 Highway 43 S
Picayune, MS 39466-8141

Phone

(601) 347-9024

Fax

(601) 798-5914

NPI assigned

Feb 21, 2014

Last updated

Nov 15, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS, LA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ochsner Mississippi, LLC

  • Internal Medicine Physician
  • Bay Saint Louis, MS
  • NPI 1538674239
  Medicare reassignment NPD
• Ochsner Clinic LLC

  • General Practice Physician
  • New Orleans, LA
  • NPI 1538151428
  Medicare reassignment NPD
• Ochsner Mississippi, LLC

  dba Ochsner Urgent Care & Occupational Health - Diamondhead

  • Internal Medicine Physician
  • Diamondhead, MS
  • NPI 1316662059
  NPD
• Ochsner Mississippi, LLC

  dba Ochsner Pediatric Plastic Surgery

  • Internal Medicine Physician
  • Hattiesburg, MS
  • NPI 1568026425
  NPD
• Ochsner Clinic LLC

  dba Diabetes Prevention Program

  • Registered Dietitian
  • Covington, LA
  • NPI 1013747039
  NPD
• Ochsner Clinic LLC

  dba Ochsner CHRISTUS Health Center - Tybee Lane

  • Internal Medicine Physician
  • Lake Charles, LA
  • NPI 1306318928
  NPD
• Slidell Memorial Hospital

  • General Acute Care Hospital
  • Slidell, LA
  • NPI 1578568481
  NPD (past)

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

{
    "created_epoch": "1392940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1790100113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 JEFFERSON HWY",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701212429",
            "telephone_number": "504-842-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2274 HIGHWAY 43 S",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394668141",
            "telephone_number": "601-347-9024",
            "fax_number": "601-798-5914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "554 Keily Street",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32212",
            "country_code": "US",
            "telephone_number": "757-953-7550",
            "fax_number": "757-953-7560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "COURTNEY",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-21",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "1790100113",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "29407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Children's International, LLC (Children's International Medical Group)
• Children's International, LLC
• City Caremeds Pharmacy LLC
• City Rexall Drugs II Inc (City Rexall Drugs Inc)
• City Rexall Drugs Inc
• Clever Recovery
• Patrizia M. Colbert, MD
• Horace Eugene Combs III, D.M.D.
• Communication Connection, LLC
• Community Home Care Pharmacy Inc. (Failla's Vital Care)

• Pediatrics Physician in Picayune, MS
• Providers in Picayune, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; 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.