Vontisha Shavron Clark

Primary specialty

DriverTaxonomy code 172A00000X

License

CLA806348 Issued in ND

Practice address

3315 2ND Ave E Apt 102
Williston, ND 58801-2815

Phone

(701) 651-6625

Fax

(701) 651-6625

NPI assigned

Jun 19, 2025

Last updated

Jun 19, 2025By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1750291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1972490258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3315 2ND AVE E APT 102",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588012815",
            "telephone_number": "701-651-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 2ND AVE E APT 102",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588012815",
            "telephone_number": "701-651-6625",
            "fax_number": "701-651-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "VONTISHA",
        "middle_name": "SHAVRON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-19",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "ND",
            "license": "CLA806348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Madison Clair, DO
• Christina Clark, CERTIFIED MHT
• Danilynn Marie Clark, LAC
• Leeann Clark
• Susan Marie Clark, BA
• Kassandra Cachet Clarys
• Clinical Consulting P.C.
• Cheyenne Rose Clinton
• Rebecca Clouse
• William E Code, MD

• Driver in Williston, ND
• Providers in Williston, ND by specialty
• Driver in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.