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1932060142 NPI number — MADELYN CLARK

NPI Number: 1932060142
Health Care Provider/Practitioner: MADELYN CLARK

Information about “1932060142” NPI (MADELYN CLARK) exists in 1932060142 in HTML format HTML  |  1932060142 in plain Text format TXT  |  1932060142 in PDF (Portable Document Format) PDF  |  1932060142 in an XML format XML  formats.

NPI Number : 1932060142 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1932060142",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLARK",
    "FirstName": "MADELYN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BEDGOOD",
    "OtherFirstName": "MADELYN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "401 GINGER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANNA",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75409-1275",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "903-449-2260",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6842 MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRISCO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75033-4243",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "469-633-9300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/19/2025",
    "LastUpdateDate": "11/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA19787",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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