MR. PHILLIP WAYNE CLARK DNP NPI 1629471412

NPI Information

  • NPI: 1629471412
  • Provider Name: MR. PHILLIP WAYNE CLARK, DNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2501 N STOCKTON HILL RD STE 108
    KINGMAN, AZ
    ZIP 86401
  • Phone: (928) 255-5050

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NPI Details

MR. Phillip Wayne Clark, DNP is a family nurse practitioner in Kingman, AZ. MR. Phillip Wayne Clark, DNP NPI is 1629471412. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2501 N STOCKTON HILL RD STE 108
KINGMAN, AZ
ZIP 86401-140
Phone: (928) 255-5050
Fax: (888) 571-5897

The NPI 1629471412 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/7/2014 and was last updated on 5/23/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily2014034806MISSOURINo
2363LF0000XNurse PractitionerFamilyCNP-02553NEW MEXICONo
3363LF0000XNurse PractitionerFamilyAP 7468ARIZONAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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