Myrlita Shawn Clark, NP,C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

SPO10333 Issued in PA

Practice address

1999 W Hunting Park Ave
Philadelphia, PA 19140-2828

Phone

(215) 228-9300

Fax

(215) 228-9913

NPI assigned

Jun 4, 2009

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

Enrolled in PA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: myrlita.clark.p1@direct.gpha.nextgenshare.com

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.

• Greater Philadelphia Health Action Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1205140902
  Medicare reassignment NPD
• Greater Philadelphia Health Action, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1275151607
  NPD

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1871729889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 N 6TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191234004",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402828",
            "telephone_number": "215-228-9300",
            "fax_number": "215-228-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MYRLITA",
        "middle_name": "SHAWN",
        "name_prefix": "Ms.",
        "credential": "NP,C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-04",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SPO10333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Paul Clark, MD
• Maurice Clark
• Maya Nicole Clark, PHD, ACNP-BC
• Michael Goubeaux Clark
• Michael Thomas Clark, CRNP
• Nicole Clark
• Norman Charles Clark, D.M.D
• Rachael Clark, M.D.
• Randall Clark, LCSW
• Richard Joseph Clark, D.M.D.

• Gerontology Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Gerontology Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; 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.