ADELE CLARK (NPI# 1841228335) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1841228335 |
Entity Type | Individual |
Full Name | ADELE CLARK |
Credential | PA |
Practice Address |
4618 Country Club Rd Winston Salem NC 27104-3520 |
Mailing Address |
Po Box 344 Winston-salem NC 27102-0344 |
Practice Telephone | 3367162255 |
Practice Fax Number | 3367169258 |
Mailing Telephone | 3367162255 |
Mailing Fax Number | 3367169258 |
Enumeration Date | 2006-06-30 |
Last Update Date | 2010-10-21 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
100690 | NC | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NC | MEDCOST | 189348 | 01 |
NC | AETNA | 7825786 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962863753 | Adele Jane Clark | Chiropractor | 23100 Pacific Hwy S Ste 201, Des Moines, WA 98198-7281 | 2016-03-08 |
Street Address |
4618 COUNTRY CLUB RD |
City | WINSTON SALEM |
State | NC |
Zip Code | 27104-3520 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720063175 | Steven Richard Feldman | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-08 |
1487213047 | Diana Isabel Munoz Ali | Nurse Practitioner | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2019-06-07 |
1629544689 | Kimberly Kincaid Mcpeeks | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2018-10-17 |
1861842031 | Leonora Culp Bomar | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2016-06-17 |
1912392903 | Melissa Brooke Hoffman | Student in an Organized Health Care Education/Training Program | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2015-04-06 |
1083031090 | Jessica Alexis Savas | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2014-03-27 |
1164779997 | Amber Brewer Keller | Physician Assistant | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2012-08-10 |
1629272455 | William Wei-ting Huang | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2007-06-14 |
1316923360 | Joseph Lucius Jorizzo | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-21 |
1518943943 | Phillip Mabon Williford | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-19 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1447807664 | Cameron Grant Ford | Psychologist | 614 Country Club Road, Winston-salem, NC 27104 | 2019-08-22 |
1104310374 | Novant Medical Group, Inc. | Internal Medicine | 4937 Old Country Club Rd, Winston Salem, NC 27104 | 2018-06-20 |
1982100509 | Dillon James Magalski | Student in an Organized Health Care Education/Training Program | Piedmont Plaza 1, 1920 West First Street, Wake Forest Baptist Medical Center, Winston-salem, NC 27104 | 2018-04-03 |
1891290144 | Breann M Poling | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Center, Department Of, Family Medicine Piedmont Plaza I 1920 West First Street, Winston Salem, NC 27104 | 2018-03-28 |
1689178600 | Christopher Vasil | Student in an Organized Health Care Education/Training Program | Piedmont Plaza I, 1920 West First Street, Department of Family Medicine, Winston Salem, NC 27104 | 2018-03-23 |
1407379126 | April Lynn Lowe | Registered Nurse | 940 N Peace Haven Rd, Winstonsalem, NC 27104 | 2017-07-25 |
1164950804 | Donald Joyce | Student in an Organized Health Care Education/Training Program | 1920 West First St, Piedmont Plaza I Building, 3rd Floor, Winston-salem, NC 27104 | 2017-05-25 |
1255867289 | Benjamin Hansen | Pharmacist | 2150 Country Club Rd Ste 300, Winston Salem, NC 27104 | 2017-05-11 |
1770020976 | Jane Reed | Physical Medicine & Rehabilitation | 2627 E Greenbrier Road, Winston Salem, NC 27104 | 2017-01-25 |
1053728261 | Ashraf Alsaedi | Pharmacist | 1659 Stratford Rd Nw, Winston Salem, NC 27104 | 2014-07-20 |
Find all providers in zip 27104 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629692439 | Julie Anne Augustine | Physician Assistant | 718 S Green St, Winston Salem, NC 27101-5112 | 2020-06-08 |
1932674090 | Erin Baxter Caldwell | Physician Assistant | 2953 Buena Vista Rd, Winston Salem, NC 27106-5724 | 2018-10-04 |
1376054106 | Tara Mckenzie | Physician Assistant | 1 Medical Center Blvd Hosptial Medicine, Winston Salem, NC 27157-0001 | 2017-10-19 |
1154866382 | Camilla Potts Leonard | Physician Assistant | 503 Thurston St, Winston Salem, NC 27103-1609 | 2016-12-26 |
1427591379 | Darrell Justin Ratcliffe | Physician Assistant | 1500 W Academy St, Winston Salem, NC 27103-3849 | 2016-11-27 |
1881825917 | Mark Elno Archambault | Physician Assistant | Department of Physician Assistant Studies, Medical Center Blvd, Winston Salem, NC 27157-1006 | 2009-08-06 |
1659519551 | John Clifton Harper Jr. | Physician Assistant | 206 W Clemmonsville Rd, Winston Salem, NC 27127-5124 | 2009-01-30 |
1710070602 | John Joseph Dewar Sr. | Physician Assistant | 1399 Ashleybrook Ln Ste 100, Winston Salem, NC 27103-2961 | 2006-10-02 |
1871515866 | Beth Gurley | Physician Assistant | 765 Highland Oaks Dr, Suite 100, Winston Salem, NC 27103-7101 | 2006-07-25 |
1801845722 | Mark A Pane | Physician Assistant | 3333 Brookview Hills Blvd Ste 104, Winston Salem, NC 27103-5661 | 2006-05-08 |
Find all providers in WINSTON SALEM |
City | WINSTON SALEM |
Zip Code | 27104 |
Please comment or provide details below to improve the information on ADELE 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.