Shannon Denise Clark, CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.023853 Issued in OH

Practice address

2 Easton Oval Ste 450
Columbus, OH 43219-6035

Phone

(614) 475-9500

Fax

(614) 475-9821

NPI assigned

Mar 12, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shannon Denise Large Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Nurse Practitioner

Education

Ohio State University College of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Matrix Integrated Psychological ServicesGroup PAC ID 4880750512, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified 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.

• Matrix Integrated Psychological Services

  • Psychologist
  • Columbus, OH
  • NPI 1902079478

  Multi-Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544486400000",
    "number": "1881726271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 EASTON OVAL STE 450",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432196035",
            "telephone_number": "614-475-9500",
            "fax_number": "614-475-9821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 EASTON OVAL STE 450",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432196035",
            "telephone_number": "614-475-9500",
            "fax_number": "614-475-9821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8256 Harrisburg Rd",
            "address_purpose": "LOCATION",
            "city": "Orient",
            "state": "OH",
            "postal_code": "431469528",
            "country_code": "US",
            "telephone_number": "614-877-3631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNON",
        "middle_name": "DENISE",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2018-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.023853",
            "primary": true
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "OH",
            "license": "RN-253819",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2716887",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "LARGE",
            "middle_name": "DENISE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paula Anne Clark, M.S.,O.T.R.L.
• Rachel Anne Clark, AG-ACNP
• Rebecca Clark, RN
• Rhonda Clark
• Sarah Clark
• Sharon Santoso Clark, M.D.
• Tamara Delavigne Clark, MS, RN, CPNP-AC
• Tara Marie Clark, MPT
• Taylor Nicole Clark, PHARMD
• Teresa Sha Clark, LISW-S

• Psychiatric/Mental Health Nurse Practitioner in Columbus, OH
• Providers in Columbus, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; 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.