Katherine Clark, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

23185 Issued in CA

Practice address

650 Clark Way
Palo Alto, CA 94304

Phone

(650) 688-3644

Fax

(650) 688-3669

NPI assigned

Apr 19, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

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

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382918400000",
    "number": "1841557428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 CLARK WAY",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "94304",
            "telephone_number": "650-688-3644",
            "fax_number": "650-688-3669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 CLARK WAY",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "94304",
            "telephone_number": "650-688-3644",
            "fax_number": "650-688-3669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATHERINE",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-19",
        "last_updated": "2013-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5005585",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5005585",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "23185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Palo Alto
• Cody William Civiletto, MD
• David J Clark, MD/PHD
• Dean W Clark, DDS
• Jeffry Russell Clark, MFC
• Kelsey Allison Clark, PHD
• Kevin Lewis Clark, MSW
• Mary Clark, AU.D.
• Melissa Clark, M.D.
• Sean Clark, MD

• Pediatric Nurse Practitioner in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Pediatric Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2013; 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.