Active NPI
Christine R Clark, RD, LD, CDE
- Registered Dietitian
- Fayetteville, AR
National Provider Identifier
1902042229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 326
- Practice address
- 3 East Appleby Rd.
Suite 202
Fayetteville, AR 72703-4424 - Phone
- (479) 404-1140
- Fax
- (479) 404-1141
- NPI assigned
- Dec 17, 2008
- Last updated
- Oct 3, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 326 | AR | Primary |
Addresses
Primary practice location
3 East Appleby Rd.
Suite 202
Fayetteville, AR 72703-4424
Mailing address
PO Box 550
Lowell, AR 72745
Phone (479) 463-7775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 326 | AR | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506988800000",
"number": "1902042229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 550",
"city": "LOWELL",
"state": "AR",
"postal_code": "72745",
"telephone_number": "479-463-7775",
"fax_number": "479-463-7187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 EAST APPLEBY RD.",
"address_2": "SUITE 202",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034424",
"telephone_number": "479-404-1140",
"fax_number": "479-404-1141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHRISTINE",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "RD, LD, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-17",
"last_updated": "2017-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AR",
"license": "326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.