John P Clark, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10001599 Issued in WA

Practice address

101 Camelia St NW
Royal City, WA 99357

Phone

(509) 346-1447

Fax

(509) 346-1481

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Clinic at Royal City

  • Non-Pharmacy Dispensing Site
  • Royal City, WA
  • NPI 1962586503
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811922982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1028",
            "address_2": "101 CAMELIA ST NW",
            "city": "ROYAL CITY",
            "state": "WA",
            "postal_code": "99357",
            "telephone_number": "509-346-1447",
            "fax_number": "509-346-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CAMELIA ST NW",
            "city": "ROYAL CITY",
            "state": "WA",
            "postal_code": "99357",
            "telephone_number": "509-346-1447",
            "fax_number": "509-346-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10001599",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA11682",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leane Austin, RN
• Eunice Guadalupe Barragan
• Laura Broussard, APRN
• Central Washington Health Services Assocation
• Central Washington Health Services Association
• Clinic at Royal City
• Columbia Basin Health Association
• County of Grant
• Bruce R Douglas, PA
• Alisha Eilers, MA-CCC-SLP

• Medical Physician Assistant in Royal City, WA
• Providers in Royal City, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.