Renna Clark, NURSE PRACTITIONER

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

0024184881 Issued in VA

Practice address

955 E Wonder Rd
Stafford, VA 22554

Phone

(540) 741-7893

Fax

(540) 741-9778

NPI assigned

Sep 21, 2022

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

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Nurse Practitioner

Education

Kent State University College of Podiatric Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mary Washington Healthcare PhysiciansGroup PAC ID 2769546530, 286 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mary Washington Hospital Hospital, Fredericksburg, VA, CCN 490022

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rclark119427@marywashingtonhealthcare.direct-ci.com

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.

• Mary Washington Healthcare Physicians

  • Family Medicine Physician
  • Fredericksburg, VA
  • NPI 1295999852
  Medicare reassignment Care Compare group NPD
• Mary Washington Healthcare Physicians

  • Durable Medical Equipment & Medical Supplies
  • Fredericksburg, VA
  • NPI 1740853035
  NPD
• Zerline Chambers-Kersey MD PC

  • Medical Specialty Clinic/Center
  • Dumfries, VA
  • NPI 1225185762
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mary Washington Hospital Inc.

  • General Acute Care Hospital
  • Fredericksburg, VA
  • NPI 1942288527
  Care Compare affiliation
• Mary Washington Hospital, Inc.

  • Cardiovascular Disease Physician
  • Fredericksburg, VA
  • NPI 1013089879

  Hospital

  Care Compare affiliation
• Mary Washington Hospital, Inc.

  • Home Health Agency
  • Fredericksburg, VA
  • NPI 1407814163

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1992428361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3775 FETTLER PARK DR UNIT A5",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220251946",
            "telephone_number": "703-441-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 E WONDER RD",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "22554",
            "telephone_number": "540-741-7893",
            "fax_number": "540-741-9778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3775 Fettler Park Dr Unit A5",
            "address_purpose": "LOCATION",
            "city": "Dumfries",
            "state": "VA",
            "postal_code": "220251946",
            "country_code": "US",
            "telephone_number": "703-441-3555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RENNA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-21",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "VA",
            "license": "0024184881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patanit Chupashko, LMT, MMP
• Clarity Clinical Counseling Services
• Angelina Clark
• Jordan Clark
• Mary Susan Clark, OTR/L
• Tara Clark
• Alysia Clawson
• Katrina Clement, LCSW
• Kailyn Clements
• Gracie Randolph Cline

• Women's Health Nurse Practitioner in Stafford, VA
• Providers in Stafford, VA by specialty
• Women's Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.