Tina Marie Clark, FSP

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

411 S Central Ave
Idabel, OK 74745-6059

Phone

(580) 286-5045

Fax

(580) 286-5721

NPI assigned

Dec 29, 2017

Last updated

Dec 29, 2017By the provider in NPPES

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

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

{
    "created_epoch": "1514505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514505600000",
    "number": "1871000877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1030",
            "city": "ANTLERS",
            "state": "OK",
            "postal_code": "745231030",
            "telephone_number": "580-298-2830",
            "fax_number": "580-298-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 S CENTRAL AVE",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747456059",
            "telephone_number": "580-286-5045",
            "fax_number": "580-286-5721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "credential": "FSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-29",
        "last_updated": "2017-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Choctaw Nation of Oklahoma (Choctaw Nation Health Clinic-Idabel)
• Choctaw Nation of Oklahoma (Choctaw Nation Health Clinic-Idabel RX)
• City Drug of Idabel Inc (City Drug)
• Julie Clark
• Samuel Edward Clark, B.S.W.
• Kasey E Clements
• Cailey Clouse
• Kristen Michelle Clouse, APRN CNP
• Rebecca Rose Clouse, BHRS, B.A.
• Sara Ann Collier, MD

• Peer Specialist in Idabel, OK
• Providers in Idabel, OK by specialty
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2017; 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.