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Deactivated NPI 1114122348 Deactivated / Inactive NPI Female Practitioner

Dolores E Clark , PNP

Nurse Practitioner - Pediatrics • Grapevine, TX

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dolores Clark has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 18, 2007
NPI Deactivation Date February 25, 2019
Total Practice Duration ~12 Years of Practice (2007 – 2019)

Professional Overview & Biography Verified Profile Summary

Dolores Clark, PNP was a registered Nurse Practitioner - Pediatrics practicing in Grapevine, TX. Throughout an active medical career spanning 12 years, Dolores Clark provided care at the practice location at 3801 WILLIAM D TATE AVE until profile deactivation on 2019-02-25.

Practice Location & Contact Primary Location

Practice Address

3801 William D Tate Ave
Ste 200

Grapevine, TX 760518755

Telephone 8174166644
Fax 8174242882
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner - Pediatrics in Grapevine, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 8.0 Yrs
Regional Practice Density
8 Specialists

Practicing in Grapevine, TX (2253 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Nurse Practitioner - Pediatrics Primary Specialty

NUCC Taxonomy Code: 363LP0200X

State License TX 211820

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Kristi Kohl , MED, LPC

Counselor - Mental Health

NPI 1770954778

Master of Education, Licensed Professional Counselor

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated February 25, 2019

Record deactivated on February 25, 2019

NPI Profile Active April 13, 2010

NPI status registered as active in NPPES database

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Updated Practice Location April 13, 2010

Registered at 3801 WILLIAM D TATE AVE, STE 200, GRAPEVINE, TX 760518755 (Tel: 8174166644)

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Updated Business Mailing Address April 13, 2010

Registered at PO BOX 99371, FORT WORTH, TX 761990371 (Tel: 6828851855)

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Provider Name / Credentials Updated April 13, 2010

Recorded as DOLORES CLARK, PNP

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 13, 2010

Nurse Practitioner (License #211820 in TX)

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Initial NPI Registration & Enumeration June 18, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114122348
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 18, 2007
Last Update: April 13, 2010
Deactivation Date: February 25, 2019

Mailing Address

Po Box 99371

Fort Worth, TX 761990371

Phone: 6828851855

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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