Mary Kimberly Clarke, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

0900036 Issued in NC

Practice address

500 Carolina Meadows
Chapel Hill, NC 27517-8471

Phone

(919) 370-7102

Fax

(919) 942-0377

NPI assigned

Mar 23, 2007

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209600000000",
    "number": "1801913801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CAROLINA MEADOWS",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275178510",
            "telephone_number": "919-942-4014",
            "fax_number": "919-942-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CAROLINA MEADOWS",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275178471",
            "telephone_number": "919-370-7102",
            "fax_number": "919-942-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "MARY",
        "middle_name": "KIMBERLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2008-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "0900036",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "900035",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN PTAN",
            "identifier": "2592857A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "811995",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "561380014G",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Clark
• Vivian Elizabeth Clark, MD
• Wendy Auclair Clark, D.D.S.
• Casey Allen Clarke, PA-C
• Lilah E Clarke
• Megan Michelle Clarke, PHARMD
• Jasnique Clayton
• Nancy Clayton, MD
• Eileen Cleary, LPC
• Elise Marie Clemens, MD

• Adult Health Nurse Practitioner in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• Adult Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.

Verify at the official NPI Registry.