SANDRA CLARK (NPI# 1578692463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578692463 |
| Entity Type | Individual |
| Full Name | SANDRA CLARK |
| Other Name | JASON CLARK |
| Credential | RT(R) |
| Practice Address |
139 County Road 379 Water Valley MS 38965-3607 |
| Practice Telephone | 6625145215 |
| Mailing Telephone | 6625145215 |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2471C3402X |
Radiologic Technologist Specialization: Radiography |
MRT2279 | MS | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09851011 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013526631 | Sandra Clark | Counselor | 205 N College Avenue, Suite 210a, Bloomington, IN 47404 | 2020-07-29 |
| 1013568039 | Sandra D Clark | Technician | 718 W 14th St, Junction City, KS 66441-2129 | 2019-09-20 |
| 1972980001 | Sandra Clark | Counselor | 66950 Ironwood Dr Apt 223, Desert Hot Springs, CA 92240-4401 | 2015-04-27 |
| 1154750586 | Sandra Clark | Social Worker | 3805 Woodside Dr, Sanford, NC 27332-8110 | 2013-11-06 |
| 1205142106 | Sandra Denice Clark | Counselor | 5701 N Hills St, Meridian, MS 39307-2903 | 2010-08-30 |
| 1003141425 | Sandra Ellen Clark | Speech-Language Pathologist | 242 Maple Dr, Shippenville, PA 16254-9022 | 2009-10-03 |
| 1487890489 | Sandra Marie Clark | Registered Nurse | 312 E 207th St, Bronx, NY 10467-4202 | 2008-12-21 |
| 1669623708 | Sandra Kay Clark | Behavioral Analyst | 16503 W Mckinley St, Goodyear, AZ 85338-6170 | 2008-10-07 |
| 1669696019 | Sandra Clark | Social Worker | 534 S Terrace Rd, Chandler, AZ 85226-4626 | 2007-04-13 |
| 1003915414 | Sandra Singleton Clark | Registered Nurse | 157 Paragon Pkwy, Clyde, NC 28721-9463 | 2006-09-22 |
| Street Address |
139 COUNTY ROAD 379 |
| City | WATER VALLEY |
| State | MS |
| Zip Code | 38965-3607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912185927 | Jason H Clark & Sandra J Clark | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 139 County Road 379, Water Valley, MS 38965-3607 | 2008-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083087985 | Family Health Care Clinic, Inc. | Clinic/Center | 102 Blackmur Dr, Water Valley, MS 38965 | 2015-11-02 |
| 1770713893 | Ben F Toole | Counselor | 1285 County Road 151, Water Valley, MS 38965 | 2009-07-23 |
| 1053451880 | North Mississippi Foot Specialists PC | Durable Medical Equipment & Medical Supplies | 630 South Main St, Water Valley, MS 38965 | 2007-02-08 |
| 1003977281 | Barney Lee Pullen Jr. | Dentist | 117 Wood St, Water Valley, MS 38965 | 2006-12-12 |
| 1912070277 | Water Valley Rural Health Paul Odom Md | Clinic/Center | 645 South Main Street, Water Valley, MS 38965 | 2006-11-16 |
| 1255414173 | Family Practice Clinic of Water Valley | Family Medicine | 606 So Main St, Water Valley, MS 38965 | 2006-10-23 |
| 1073609467 | Paul Leroy Odom | Family Medicine | 604 South Main Street, Water Valley, MS 38965 | 2006-10-05 |
| 1730129164 | Quality Medical Service, Inc | Durable Medical Equipment & Medical Supplies | Quality Medical Services, Inc, 48 S Main Street, Water Valley, MS 38965 | 2006-06-07 |
| 1124687207 | Dontavious Toles | Physical Therapy Assistant | 50 Main St, Water Valley, MS 38965 | 2019-06-11 |
| 1669826111 | Antoinette Taylor | Family Medicine | 604 S Main St, Water Valley, MS 38965 | 2016-04-21 |
| Find all providers in zip 38965 | ||||
| Taxonomy Code | 2471C3402X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Radiography |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184801201 | Magnolia Imaging LLC | Radiologic Technologist | 3890 Bienville Blvd, Ocean Springs, MS 39564-5803 | 2008-01-31 |
| 1851583314 | Robert W Gray | Radiologic Technologist | 1560 Sumrall Rd, Columbia, MS 39429-2654 | 2007-08-17 |
| City | WATER VALLEY |
| Zip Code | 38965 |
Please comment or provide details below to improve the information on SANDRA CLARK.
| 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.