Elise N. Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP128458 Issued in TX

Practice address

5473 Blair Rd Ste 100
Dallas, TX 75231-4227

Phone

(972) 850-0687

NPI assigned

Jul 7, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elise N. Lewis Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Credentials

Nurse Practitioner

Practice roles

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.

• Health Rejuvenation Specialists

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1144567363
  NPD (past)
• Renewed Vitality LLC

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1578849634
  NPD (past)

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1962885145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5473 BLAIR RD STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314227",
            "telephone_number": "972-850-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5473 BLAIR RD STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314227",
            "telephone_number": "972-850-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELISE",
        "middle_name": "N.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-07",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP128458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3502510-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISE",
            "last_name": "LEWIS",
            "middle_name": "N.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Camille Clark, MD
• Chelsey Marie Clark
• Cheyla Romaine Clark, MPH, MS, CGC
• Deborah Jean Clark, LMSW,LMFT
• Edward Williams Clark, M.D.
• Elizabeth Maurine Clark, APRN, FNP-BC
• Ethan Clark, MA, LPC
• Gary R Clark, D.O.
• Glenn D Clark, DDS
• Gordon Michael Clark Sr., M.D.

• Family Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.