Active NPI
Crystal Dawn Clark, LPN
- Licensed Practical Nurse
- Wheelersburg, OH
National Provider Identifier
1942503198
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Dec 20, 2023.
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 142164
- Practice address
- 28 B Miller Road
Wheelersburg, OH 45694-8103 - Phone
- (740) 285-6493
- NPI assigned
- Dec 9, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 142164 | OH | Primary |
Addresses
Primary practice location
28 B Miller Road
Wheelersburg, OH 45694-8103
Mailing address
PO Box 656
Wheelersburg, OH 45694-0656
Phone (740) 285-6493
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3146303 | Medicaid | OH |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 142164 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413158400000",
"number": "1942503198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 656",
"city": "WHEELERSBURG",
"state": "OH",
"postal_code": "456940656",
"telephone_number": "740-285-6493"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 B MILLER ROAD",
"city": "WHEELERSBURG",
"state": "OH",
"postal_code": "456948103",
"telephone_number": "740-285-6493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CRYSTAL",
"middle_name": "DAWN",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-09",
"last_updated": "2014-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "142164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3146303",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheelersburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.