Shanna G Clark, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

277227 Issued in NY

Practice address

130 White Birch Est
Fort Edward, NY 12828-9275

Phone

(518) 415-8643

NPI assigned

Oct 18, 2012

Reactivated

Oct 28, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1831442698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 WHITE BIRCH EST",
            "city": "FORT EDWARD",
            "state": "NY",
            "postal_code": "128289275",
            "telephone_number": "518-415-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 WHITE BIRCH EST",
            "city": "FORT EDWARD",
            "state": "NY",
            "postal_code": "128289275",
            "telephone_number": "518-415-8643"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "357 Milton Ave",
            "address_purpose": "LOCATION",
            "city": "Ballston Spa",
            "state": "NY",
            "postal_code": "120201441",
            "country_code": "US",
            "telephone_number": "518-491-2806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNA",
        "middle_name": "G",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "deactivation_date": "2020-10-21",
        "reactivation_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "277227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Lyne Brooks, RN
• Christina Campagna Rees, MSW
• Leslie Carpenter, LPN
• Gregory N Chandler, LCSW
• Jeff Chatterton, EMT B
• Lynda R Coccaro
• Tara M Cornell, NPP
• County of Washington New York
• Rachael Cutter, OTR/L
• Donna M Dapolito, LCSWR

• Licensed Practical Nurse in Fort Edward, NY
• Providers in Fort Edward, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.