KOURTNEY LECIERA CLARK (NPI# 1467088070) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467088070 |
| Entity Type | Individual |
| Full Name | KOURTNEY LECIERA CLARK |
| Practice Address |
2728 Euclid Ave Cleveland OH 44115-2429 |
| Mailing Address |
261 Summerfern Ln Columbus OH 43213-7642 |
| Practice Telephone | 2166005194 |
| Mailing Telephone | 2163339995 |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-03-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 172V00000X | Community Health Worker | OH | Other Service Providers | |
| Y | 171M00000X | Case Manager/Care Coordinator | OH | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447682521 | Kourtney Gisell Clark | Audiologist | 5420 Dashwood Dr, 310, Houston, TX 77081-5357 | 2013-07-31 |
| Street Address |
2728 EUCLID AVE |
| City | CLEVELAND |
| State | OH |
| Zip Code | 44115-2429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942836309 | Shirley Tucker | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-18 |
| 1366056293 | Karla Cobern | Student in an Organized Health Care Education/Training Program | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-09-08 |
| 1558989780 | Roderick Coffee II | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-07-14 |
| 1265060222 | Raymond Cox | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-27 |
| 1265060123 | Dominique Stephens | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-27 |
| 1902432321 | Adrienne Williams | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-17 |
| 1093341851 | Derrick Fair | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-12 |
| 1912533746 | Vernon Tyus | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-12 |
| 1205461027 | Duanne Dunn | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-12 |
| 1225663784 | Tracy Simpkins-smith | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972117299 | Ann Marie Louise Melinz | Counselor | 2525 West 22nd Street, Cleveland, OH 44115 | 2020-09-03 |
| 1881231850 | Steven Kelly | Case Management | 3500 Carnegie Ave., Cleveland, OH 44115 | 2019-12-09 |
| 1649821422 | Larry Hollimon | Technician | 2320 East 30th Street, Apt #1304, Cleveland, OH 44115 | 2019-09-24 |
| 1306332408 | Tyler Milam | Counselor | 2334 Prospect Ave., 400, Cleveland, OH 44115 | 2018-07-02 |
| 1780108019 | Victoria Charles | Registered Nurse | 2500 E. 22nd St, Cleveland, OH 44115 | 2017-07-28 |
| 1528580511 | Randol Jamel Kennedy | Internal Medicine | 2351 East 22nd Street Suite 338 W, St. Vincent Charity Medical Center, Cleveland, OH 44115 | 2017-07-11 |
| 1508393422 | Gang Anthony Lu | Dentist | 1110 Euclid Ave Ste 202, Cleveland, OH 44115 | 2017-05-23 |
| 1093116501 | Megan Shiles | Psychologist | 2675 East 30th St., Cleveland, OH 44115 | 2014-09-16 |
| 1003224577 | Efewongbe Benedicta Oleghe | Internal Medicine | 2351 E 22nd Street, St Vincent's Charity Medical Center, Cleveland, OH 44115 | 2014-07-29 |
| 1982032074 | Andrew Winchester | Social Worker | 2500 Carnegie Ave, Cleveland, OH 44115 | 2013-10-29 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922606755 | Kathy Ann Miller | Case Manager/Care Coordinator | 296 Colony Ln Nw, Cleveland, TN 37312-6411 | 2020-10-14 |
| 1437766243 | Marie L Clay | Case Manager/Care Coordinator | 8200 Rosewood Ave # Up, Cleveland, OH 44105-6683 | 2020-09-25 |
| 1073123311 | King Malone IIi | Case Manager/Care Coordinator | 1193 E 172nd St, Cleveland, OH 44119-3153 | 2020-08-02 |
| 1750990727 | Reginald Bagley I | Case Manager/Care Coordinator | 2728 Euclid Ave Ste 4004th, Cleveland, OH 44115-2429 | 2020-07-27 |
| 1497364681 | James Gordon | Case Manager/Care Coordinator | 896 E 73rd St, Cleveland, OH 44103-1792 | 2020-07-24 |
| 1558988204 | Jamil Brooks | Case Manager/Care Coordinator | 23612 Mccann St, Cleveland, OH 44128-5250 | 2020-06-29 |
| 1629692801 | Theodore Williams Iv | Case Manager/Care Coordinator | 7271 Engle Rd Ste 207, Cleveland, OH 44130-8404 | 2020-06-03 |
| 1629690920 | Vincent Van Johnson | Case Manager/Care Coordinator | 17325 Euclid Ave Ste 4028, Cleveland, OH 44112-1270 | 2020-05-11 |
| 1932728508 | Janayia Thompson | Case Manager/Care Coordinator | 12395 Mccracken Rd # A-up, Cleveland, OH 44125-2967 | 2020-04-13 |
| 1942836309 | Shirley Tucker | Case Manager/Care Coordinator | 2728 Euclid Ave, Cleveland, OH 44115-2429 | 2020-03-18 |
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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.