CLARK CARROLL (NPI# 1962773648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962773648 |
| Entity Type | Individual |
| Full Name | CLARK CARROLL |
| Other Name | CLARK T. CARROLL |
| Credential | APNP |
| Practice Address |
1820 Center Ave Janesville WI 53546 |
| Mailing Address |
203 W Sunny Ln Janesville WI 53546-9091 |
| Practice Telephone | 6087551475 |
| Practice Fax Number | 6087551733 |
| Mailing Telephone | 6087551475 |
| Mailing Fax Number | 6087551733 |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2019-05-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
7914 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1962773648 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 625 W Washington Ave, Madison, WI 537032637 | 6082802700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669595880 | Clark M Carroll | Dentist | 750 Medical Center Dr, Eastman, GA 31023-6736 | 2007-04-10 |
| Street Address |
1820 CENTER AVE |
| City | JANESVILLE |
| State | WI |
| Zip Code | 53546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376012070 | Tambra Renee Daniels | Nurse Practitioner | 1820 Center Ave, Janesville, WI 53546-2802 | 2018-11-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366911489 | Latoya Christina Anderson | Counselor | 1818 Pershing Pl, Janesville, WI 53546 | 2018-11-19 |
| 1922599216 | Megan Arney | Speech-Language Pathologist | 9680, 4445 Woodgate Dr., Janesville, WI 53546 | 2018-05-23 |
| 1770089955 | Abby Marie Harnack | Registered Nurse | 3901 Teal Ln, Janesville, WI 53546 | 2018-04-05 |
| 1689983793 | Fve Mw LLC | Assisted Living Facility | 3801 North Wright Road, Janesville, WI 53546 | 2010-10-07 |
| 1831354794 | County of Rock County Clerk | Community/Behavioral Health | 3506 Hwy 51, Janesville, WI 53546 | 2008-07-21 |
| 1528225422 | Walgreen Co | Pharmacy | 2519 Kettering St, Janesville, WI 53546 | 2008-05-19 |
| 1447420351 | Michele Renee Bohland | Physical Therapy Assistant | 2540 Humes Rd, Janesville, WI 53546 | 2008-03-06 |
| 1093992158 | Emma Gene Harrell | Counselor | 203 W Sunny Lane, Janesville, WI 53546 | 2008-01-30 |
| 1457473696 | Robert Louis Fleming | Dentist | 910 Conde St, Janesville, WI 53546 | 2007-04-06 |
| 1043334121 | Contemporary Dental | Dentist | 4425 Woodgate Drive, Janesville, WI 53546 | 2007-03-16 |
| Find all providers in zip 53546 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346605680 | Linda E Callahan | Nurse Practitioner | 1000 Mineral Point Ave, Janesville, WI 53548 | 2015-12-30 |
| 1710353651 | Audrey Marian Addaquay-corey | Nurse Practitioner | 903 Mineral Point Ave, Janesville, WI 53548-2970 | 2015-08-14 |
| 1194705988 | Teresa A Terrill | Nurse Practitioner | 1 S Main St, Janesville, WI 53545-3922 | 2006-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003422726 | Wisconsin Healthcare Family Practices and Behavioral Services LLC | Nurse Practitioner | 10721 W Capitol Dr Ste G103, Wauwatosa, WI 53222-1210 | 2020-09-17 |
| 1689292856 | Julianne Margaret John | Nurse Practitioner | 3237 S 16th St Ste 310, Milwaukee, WI 53215-4526 | 2020-07-13 |
| 1356968002 | Marisa Hiley | Nurse Practitioner | W129 N7055 Northfield Drive, Menomonee Falls, WI 53051 | 2020-06-29 |
| 1932726700 | Lauren Marie Skemp | Nurse Practitioner | 1960 Hyview Rd, Cuba City, WI 53807-9718 | 2020-06-28 |
| 1235779240 | Conscious Practice, LLC | Nurse Practitioner | 119 19th St N, La Crosse, WI 54601-3724 | 2020-01-08 |
| 1073152161 | Stephanie L Ruskell | Nurse Practitioner | 3805 Spring St Ste 240, Mount Pleasant, WI 53405-1667 | 2020-01-06 |
| 1558924811 | Sarah Kathryn Garven | Nurse Practitioner | 5000 West National Ave Rm 3119, Milwaukee, WI 53295-1000 | 2019-04-22 |
| 1104394535 | Therese Ann Alm | Nurse Practitioner | 383 Williamstowne Ste 101, Delafield, WI 53018-2332 | 2018-11-03 |
| 1477079242 | Aeron Rachel Adams | Nurse Practitioner | W10237 Lake Emily Rd, Fox Lake, WI 53933 | 2017-08-14 |
| 1396140398 | Monica Gorski | Nurse Practitioner | 505 King St Ste 218, La Crosse, WI 54601-4289 | 2014-11-03 |
| Find all providers with the same taxonomy | ||||
| City | JANESVILLE |
| Zip Code | 53546 |
Please comment or provide details below to improve the information on CLARK CARROLL.
| 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.