MRS. MELISSA GAYLE CLARK (NPI# 1598776882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598776882 |
| Entity Type | Individual |
| Full Name | MRS. MELISSA GAYLE CLARK |
| Other Name | MISS MELISSA BOSTWICK |
| Credential | PA-C |
| Practice Address |
619 E Mason St Suite 4p57 Springfield IL 62701-1034 |
| Practice Telephone | 2177880706 |
| Practice Fax Number | 2175252535 |
| Mailing Telephone | 2177880706 |
| Mailing Fax Number | 2175252535 |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2014-02-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085-002601 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902336753 | Melissa Lynn Clark | Audiologist | 69 Allen St Ste 1, Rutland, VT 05701-4564 | 2017-06-14 |
| 1245764638 | Melissa Clark | Social Worker | 2906 F St, Unit 6860, Eureka, CA 95502-4101 | 2017-04-12 |
| 1861843328 | Melissa Clark | Case Manager/Care Coordinator | 21 Seneca Dr, Horseheads, NY 14845-1082 | 2016-06-27 |
| 1982054862 | Melissa A Clark | Social Worker | 3142 W Fullerton Ave Apt 1, Chicago, IL 60647-7997 | 2016-06-21 |
| 1518236900 | Melissa Yvonne Clark | Counselor | 1131 Ionia Ave Nw, Grand Rapids, MI 49503-1020 | 2011-12-14 |
| 1063799682 | Melissa Newkam Clark | Occupational Therapist | 5745 Old Winder Hwy Ste C, Braselton, GA 30517-1637 | 2011-11-10 |
| 1114160199 | Melissa Ann Clark | Licensed Practical Nurse | 113 Cheney St, Syracuse, NY 13207 | 2009-04-07 |
| 1902084858 | Melissa Clark | Registered Nurse | 3251 West 9th Street, Waterloo, IA 50702 | 2008-02-02 |
| 1447462189 | Melissa Kipp Clark | Audiologist | 5304 Manatee Ave W, Bradenton, FL 34209-3743 | 2007-05-04 |
| 1548398506 | Melissa Darlene Clark | Licensed Practical Nurse | 105 Waverly Plz, Waverly, TN 37185-1531 | 2007-03-01 |
| Street Address |
619 E MASON ST SUITE 4P57 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62701-1034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033190814 | Carl E Arentzen | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 619 E Mason St, Suite 3p25, Springfield, IL 62701-1034 | 2005-11-09 |
| 1669913349 | Laura Grubb | Internal Medicine | 619 E Mason St, Ste. 4p57, Springfield, IL 62701-1034 | 2017-03-15 |
| 1265974604 | Julie Borjon | Internal Medicine | 619 E Mason St, Suite 4p57, Springfield, IL 62701-1034 | 2016-11-16 |
| 1912358565 | Meleah Vaughan | Nurse Practitioner | 619 E Mason St, Suite 4p57, Springfield, IL 62701-1034 | 2016-06-24 |
| 1508225616 | Margaret Jordan | Internal Medicine | 619 E Mason St, Suite 4p57, Springfield, IL 62701-1034 | 2016-02-17 |
| 1487011144 | Shauna Vogler | Internal Medicine | 619 E Mason St, Springfield, IL 62701-1034 | 2016-01-25 |
| 1871987750 | Amy Durako | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 619 E Mason St, Suite 4p57, Springfield, IL 62701-1034 | 2015-03-27 |
| 1215333604 | Meredith Fleming | Internal Medicine | 619 E Mason St, Suite 4p57, Springfield, IL 62701-1034 | 2014-11-12 |
| 1154623585 | Margie Douglas | Nurse Practitioner | 619 E Mason St, Suite 4p57, Springfield, IL 62701-1034 | 2010-11-17 |
| 1326378175 | Angela K. Lafrenz | Internal Medicine | 619 E Mason St, Suite 4p57, Springfield, IL 62701-1034 | 2009-12-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687183 | Affinity Patient Coordination LLC | In Home Supportive Care | 217 E Monroe St Ste 102, Springfield, IL 62701 | 2018-07-31 |
| 1427498435 | Donald L Jacoby | Pharmacist | 701 N. First St., Springfield, IL 62701 | 2013-07-05 |
| 1700183480 | Erin Zepp | Dietitian, Registered | 319 E Madison St Ste 1f, Springfield, IL 62701 | 2011-02-16 |
| 1518117159 | Jyoti Assudani | Pediatrics | 301 N 8th Street, Springfield, IL 62701 | 2008-09-19 |
| 1396924148 | Jeanne Lyn Malone | Counselor | 408 South Fifth Street, Springfield, IL 62701 | 2007-10-29 |
| 1942422928 | Nobuharu Harada | Family Medicine | 301 N 8th, Pav-3a158, Springfield, IL 62701 | 2007-05-02 |
| 1427131127 | Radiological Associates of Decatur | Radiology | 319 E Madison Suite J, Springfield Mri & Imaging Center, Springfield, IL 62701 | 2006-10-24 |
| 1669498606 | Independence Holding Co LLC | Pharmacy | 201 North 5th Street, Springfield, IL 62701 | 2006-07-14 |
| 1720070238 | Neil J. Thomas | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 619 E Mason St Ste 4p57, Springfield, IL 62701 | 2005-08-19 |
| 1588187397 | Andrea Nicole Bloodworth | Internal Medicine | 619 E Mason St Ste 4p57, Springfield, IL 62701 | 2017-07-24 |
| Find all providers in zip 62701 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123289 | Jared Anthony Dias | Physician Assistant | 52 Devens St, Springfield, MA 01151-2304 | 2020-04-16 |
| 1659990976 | Maham Siddiqui | Physician Assistant | 8632 Hillside Manor Dr, Springfield, VA 22152-2238 | 2020-04-16 |
| 1558994772 | Kayla Rice | Physician Assistant | 3640 Main St Ste 103, Springfield, MA 01107-1139 | 2020-02-17 |
| 1487286563 | Michayla Marcil | Physician Assistant | 280 Chestnut St Fl 2, Springfield, MA 01199-1001 | 2020-02-06 |
| 1508416140 | Chase Michael Collings | Physician Assistant | 960 N 16th St Ste 303, Springfield, OR 97477 | 2019-09-16 |
| 1023670593 | Michael Peter Lembotesis | Physician Assistant | 629 Evans Rd, Springfield, PA 19064-3033 | 2019-07-03 |
| 1245795558 | Alexandra Marie Cutler | Physician Assistant | 1437 S Gelven Ave, Springfield, MO 65804-2124 | 2019-01-31 |
| 1598265894 | Kelsey L. Magill | Physician Assistant | 3231 S National Ave Ste 440, Springfield, MO 65807-7304 | 2018-02-14 |
| 1447759592 | Darrell Dewain Edwards | Physician Assistant | 4350 S National Ave Ste C200, Springfield, MO 65810-2782 | 2018-02-05 |
| 1164930087 | Ashley Jean Nichole Leutze | Physician Assistant | 1164 E Home Rd Ste J, Springfield, OH 45503-2726 | 2018-01-12 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62701 |
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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.