Stephanie Clark, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

G170123 Issued in IA

Practice address

1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318

Phone

(573) 686-4151

NPI assigned

Oct 9, 2014

Sex

Female

Sole proprietor

Yes

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

Enrolled in MO, IA, TX, IN, OH, KS, ME7 enrollments

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 7

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychiatry of Texas PLLCGroup PAC ID 0345573598, 418 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Psychiatry of Texas PLLC

  • Psychiatry Physician
  • Houston, TX
  • NPI 1013476027

  IA, MO, Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Cape Girardeau Behavioral Health LLC

  • Psychiatric Hospital
  • Cape Girardeau, MO
  • NPI 1700485281

  Psychiatric/Mental Health

  Medicare reassignment NPD
• McPherson Medical & Diagnostic, LLC

  • Clinic/Center
  • Malden, MO
  • NPI 1003407883
  Medicare reassignment NPD
• Missouri United Psych LLC

  • Psychiatry Physician
  • Cape Girardeau, MO
  • NPI 1255207023

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Psychplus Medical Associates, PLLC

  • Family Medicine Physician
  • Houston, TX
  • NPI 1558118026

  IA, MO

  Medicare reassignment NPD
• TP Health TX PC

  • Psychiatry Physician
  • Forsyth, IL
  • NPI 1518544527

  KS, ME

  Medicare reassignment NPD
• TP-Health Incorporated

  • Psychiatry Physician
  • Missouri City, TX
  • NPI 1760047526

  IN, MO, OH

  Medicare reassignment NPD
• McPherson Medical & Diagnostic, LLC

  • Family Medicine Physician
  • Kennett, MO
  • NPI 1124679774
  NPD
• McPherson Medical & Diagnostic, LLC

  • Family Medicine Physician
  • Steele, MO
  • NPI 1164440806
  NPD

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

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1851795595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013318",
            "telephone_number": "573-686-4151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013318",
            "telephone_number": "573-686-4151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHANIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-09",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2011004525",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2022026857",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G170123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Marie Cisne, FNP
• Carol Morris Clark, PHARM. D
• Donna Renee Clark
• Dorthy Carlene Clark, RN
• Kristian Clark
• Clear Stream LTC, LLC
• Clear Stream LTC, LLC
• Montanna Clemons
• Cleous Chiropractic LLC
• Katelyn Brooke Cleous, PMHNP

• Psychiatric/Mental Health Nurse Practitioner in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.