Individual provider Active NPI

Karen Elizabeth Teague Clark, PA-C

  • Physician Assistant
  • Greensboro, NC
National Provider Identifier
1811196801
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-00326 Issued in NC
Practice address
930 3Rd St
Greensboro, NC 27405-6967
Phone
(336) 890-3200
Fax
(336) 890-3290
NPI assigned
Jul 11, 2007
Last updated
Aug 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-00326 NC Primary

Addresses

Primary practice location

930 3Rd St
Greensboro, NC 27405-6967

Mailing address

930 3Rd St
Greensboro, NC 27405-6967
Phone (336) 890-3200

Other practice location 1

1414 Yanceyville Street
Greensboro, NC 27405
Phone (336) 574-8000 ext. 119

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kteagueclark245093@direct.conehealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150722004389 NC Practitioner - Physician Assistant 8820300338 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Moses H Cone Memorial Hospital Operating Corporation Physician Assistant CurrentSince Jul 27, 2015 Accepting new patients
The Moses H. Cone Memorial Hospital Operating Corporation CurrentSince Sep 1, 2019 Accepting new patients
The Moses H Cone Memorial Hospital Operating Corporation CurrentSince Jul 27, 2015 Accepting new patients

Locations

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

2525 Phillips Ave
#C
Greensboro, NC 27405
Phone (336) 832-7711

300 E Wendover Ave
Greensboro, NC 27401
Phone (336) 663-5205

930 3rd St
Greensboro, NC 27405
Phone (336) 610-3720

Interoperability endpoints

  • Direct secure messaging: kteagueclark245093@direct.conehealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1811196801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 3RD ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056967",
            "telephone_number": "336-890-3200",
            "fax_number": "336-890-3290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 3RD ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056967",
            "telephone_number": "336-890-3200",
            "fax_number": "336-890-3290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 YANCEYVILLE STREET",
            "address_purpose": "LOCATION",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "27405",
            "country_code": "US",
            "telephone_number": "336-574-8000 x119",
            "fax_number": "336-574-8008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEAGUE CLARK",
        "first_name": "KAREN",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-11",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kteagueclark245093@direct.conehealth.com",
            "affiliation": "N",
            "endpointDescription": "Cone Health Direct Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "930 3rd St",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274056967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.