Healthcare Provider Details

I. General information

NPI: 1518700459
Provider Name (Legal Business Name): SARAH MATTHES CLARK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH BETH MATTHES NP

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 W MAIN RD
MIDDLETOWN RI
02842-6301
US

IV. Provider business mailing address

15 LASALLE SQUARE
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-3110
  • Fax: 401-619-8969
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN05332
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: