Patricia Lynn Clark, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN11948 Issued in FL

Practice address

751 Oak St
601
Jacksonville, FL 32204-3359

Phone

(904) 354-4031

NPI assigned

Oct 24, 2006

Last updated

Dec 30, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451433600000",
    "number": "1871677476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 SOLANA RD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822297",
            "telephone_number": "904-280-1717",
            "fax_number": "904-280-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 OAK ST",
            "address_2": "601",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043359",
            "telephone_number": "904-354-4031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PATRICIA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2015-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN11948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Carleen Clark, MD
• Lorraine Polite Clark, DMD
• Nina Clark
• Noel Clark
• Patricia Kae Clark, PHARM.D.
• Sara E Clark, MD
• Shawn W Clark
• Shawna P Clark, CBHCMS, CMHP, HS-BCP
• Stephen Clark, M.D.
• Steven Arthur Clark, DDS

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.