Tia A Clark, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4014647 Issued in KY

Practice address

1313 Johnson Blvd
Murray, KY 42071-2925

Phone

(270) 917-1401

NPI assigned

Jan 23, 2024

Last updated

Mar 20, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tia.clark.1@19475.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aligned Health, PLLC

  • Family Nurse Practitioner
  • Murray, KY
  • NPI 1194479774
  Medicare reassignment NPD
• Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
  • NPI 1295960532
  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  KY

  Medicare reassignment NPD
• Pinelake Physician Practice LLC

  dba Jackson Purchase Primary Care Hickman Clinic

  • Rural Health Clinic/Center
  • Hickman, KY
  • NPI 1205494085
  NPD
• Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
  • NPI 1841900347
  NPD
• Pinelake Physician Practice, LLC

  dba Jackson Purchase Podiatry

  • Internal Medicine Physician
  • Mayfield, KY
  • NPI 1861563439
  NPD (past)

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

{
    "created_epoch": "1705968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1912769290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 JOHNSON BLVD",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "420712925",
            "telephone_number": "270-917-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 JOHNSON BLVD",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "420712925",
            "telephone_number": "270-917-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIA",
        "middle_name": "A",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "4014647",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "KY",
            "license": "4014647",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles D. Tucker, M.D., PSC (Murray Surgery Center)
• Mary Elisabeth Chase, D.C.
• Ryan Wesley Chasseur, PHARMD
• Hollis J Clark, MD
• Nathan Blaine Clark, APRN
• Jacob Clevenger, OTR/L
• Aliya Grace Clough, CCC-SLP
• Chadwick Hunter Cochran, PHARM.D.
• Katrina A Coffelt, LPCC
• Madison Taylor Cohoon

• Family Nurse Practitioner in Murray, KY
• Providers in Murray, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.