KATHLEEN A. CLARK MD PA (NPI# 1083085385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083085385 |
| Entity Type | Organization |
| Organization Name | KATHLEEN A. CLARK MD PA |
| Other Organization Name | SOUTHWEST ANTI-AGING CENTER |
| Practice Address |
5701 Time Square Blvd Ste 220 Amarillo TX 79119-1178 |
| Practice Telephone | 8063507311 |
| Practice Fax Number | 8063507361 |
| Mailing Telephone | 8063507311 |
| Mailing Fax Number | 8063507361 |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2017-11-09 |
| Authorized Official Name | KATHLEEN ANNE CLARK (MD) |
| Authorized Official Telephone | 8063507311 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | P8871 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | NPI | 1083085385 | 01 |
| Other Name | Type Code |
|---|---|
| Southwest Anti-Aging Center | Doing Business As Name - Organization |
| Street Address |
5701 TIME SQUARE BLVD STE 220 |
| City | AMARILLO |
| State | TX |
| Zip Code | 79119-1178 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518103886 | Kathleen Anne Clark | Internal Medicine | 5701 Time Square Blvd Ste 220, Amarillo, TX 79119-1178 | 2008-12-16 |
| 1043733793 | Brenda Nicole Stoddard | Nurse Practitioner | 5701 Time Square Blvd Ste 220, Amarillo, TX 79119-1178 | 2017-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063055135 | Cindy Kay Farley | Technician | 10511 Perry Lane #5, Amarillo, TX 79119 | 2019-10-22 |
| 1033771803 | Amy Stephenson | Dentist | 7649 Hillside Road, Suite 100, Amarillo, TX 79119 | 2019-07-02 |
| 1225535321 | Chad Pearson | Chiropractor | 8950 Soncy Rd, Suite 400, Amarillo, TX 79119 | 2018-04-06 |
| 1518418250 | Er On Soncy, LLC | Clinic/Center | 3530 S. Soncy Rd., Amarillo, TX 79119 | 2016-10-18 |
| 1003362377 | Coulter Emergency Center LLC | Clinic/Center | 5800 S. Coulter St, Amarillo, TX 79119 | 2016-08-28 |
| 1427502921 | Wilfred Omoghibora Ukhurebor | Dentist | 206 Ne 7th Avenue, Amarillo, TX 79119 | 2016-08-12 |
| 1134512031 | Susan D Sosebee | Dietitian, Registered | 7910 Progress Drive, Amarillo, TX 79119 | 2015-03-17 |
| 1467874537 | Susan Elizabeth Ellington | Internal Medicine | 7659 Hillside Rd, Suite 300, Amarillo, TX 79119 | 2014-01-09 |
| 1568776250 | Sean Woodruff | Dentist | 5051 S. Soncy Rd, Amarillo, TX 79119 | 2010-08-05 |
| 1992948368 | Christopher Aaron Atkins | Dentist | 5051 S Soncy, Amarillo Oral & Maxillofacial Surgery, Amarillo, TX 79119 | 2009-04-14 |
| Find all providers in zip 79119 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720630825 | Yalamanchili Physicians Group Pllc | Internal Medicine | 62 Prestwick Ln, Amarillo, TX 79124-4975 | 2019-07-10 |
| 1861924623 | Ryan Batson Smithee | Internal Medicine | 1301 S Coulter St Ste 107, Amarillo, TX 79106-1764 | 2017-03-31 |
| 1972967529 | David Wayne Hohon | Internal Medicine | Bsa Physician Group, 1600 Wallace Blvd., Amarillo, TX 79106 | 2016-04-11 |
| 1881074524 | Susan Mbu | Internal Medicine | 1501 Coulter Road, Amarillo, TX 79106 | 2015-06-08 |
| 1043698681 | Msj Services Pllc | Internal Medicine | 26 Medical Dr Ste A, Amarillo, TX 79106-4129 | 2015-05-15 |
| 1467874537 | Susan Elizabeth Ellington | Internal Medicine | 7659 Hillside Rd, Suite 300, Amarillo, TX 79119 | 2014-01-09 |
| 1497189526 | Saeed Md Pllc | Internal Medicine | 3144 W 28th Ave, Suite C, Amarillo, TX 79109-3169 | 2013-08-26 |
| 1922399724 | Reesha Mahnoor | Internal Medicine | 1400 Coulter Street, Ttuhsc, Amarillo, TX 79106-1708 | 2011-04-27 |
| 1457652075 | Charles W. Seward | Internal Medicine | 237 Lisa Ln, Amarillo, TX 79118-8021 | 2010-11-12 |
| 1366754673 | Lylla Ngo | Internal Medicine | 1400 S Coulter St Ste 2500, Amarillo, TX 79106-1786 | 2010-07-02 |
| Find all providers in AMARILLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.