Rebecca S. Clark, F.N.P.
Individual provider Active NPI Family Nurse Practitioner · Minden, LA
NPI 1891987343 · NPPES record last updated Apr 10, 2017
Key facts
- NPI
- 1891987343
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP05233 (LA)
- Practice address
- 10600 Industrial Dr
Minden, LA 71055-5105 - Phone
- (318) 798-4616
- Fax
- (318) 798-4619
- NPI assigned
- Aug 17, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Solutions Medical Consulting, LLC
Practice addresses (Care Compare)
1495 Frazier Rd
Ruston, LA 71270-1632
Phone (318) 202-3860
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070919000798 | LA | Practitioner - Nurse Practitioner | 0941394084 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Solutions Medical Consulting, LLC | Current |
Accepting new patients | |
| Solutions Medical Consulting, LLC | Past |
Accepting new patients | |
| American Stat - Care Centers PC Inc | Past | Accepting new patients | |
| Start Community Clinic, LLC | Past | Accepting new patients |
Locations
2404 Duval Dr
Monroe, LA 71201
Phone (318) 322-0640
1495 Frazier Rd
Ruston, LA 71270
Phone (318) 202-3860
Interoperability endpoints
- minrclark@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP05233 | LA | Yes |
Addresses
Primary practice location
10600 Industrial Dr
Minden, LA 71055-5105
Mailing address
1455 E Bert Koun Loop
Shreveport, LA 71105-5634
Phone (318) 798-4539
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1362484 | Medicaid | LA |
Other providers in Minden, LA
- Michael Scott Chanler
- Victoria Chapman
- Chess Group, LLC
- Mark Allen Cimino
- Glenda Clark
- Classic Care of Baton Rouge, Inc.
- CLHG - Minden, LLC
- CLHG - Minden, LLC
- CLHG - Minden, LLC
- CLHG-Minden, LLC
All providers in Minden, LA · Family Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.