Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1740816842 Individual Practitioner Male Practitioner

Dr. Nicholas Clark , DO

Pediatrics • Tacoma, WA

Professional Overview & Biography Verified Profile Summary

Dr. Nicholas Clark, DO is a registered healthcare professional specializing in Pediatrics in Tacoma, WA. Practice services are available at 9040 JACKSON AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

9040 Jackson Ave

Tacoma, WA 984319098

Telephone 2539681110
Associated Practice Facility / Clinic
🏢 Defense Finance & Actg Serv Facility NPI 1992784144

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Tacoma, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 22.0 Yrs
State Avg: 18.8 Yrs
Regional Practice Density
153 Specialists

Practicing in Tacoma, WA (1802 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

CMS Verified: 2025-05-07
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License VA 0102207074

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Practice Associates & Co-Workers

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

40 Associated Practitioners
Dr. Kenny Le , MD

Anesthesiology

NPI 1003351842

Doctor of Medicine (M.D.)

Elizabeth Pulatie , CRNA

Nurse Anesthetist, Certified Registered

NPI 1003913484

Certified Registered Nurse Anesthetist

Jesse Lopata , RN

Registered Nurse

NPI 1013373257

Registered Nurse

Tiffany Cavin , LPN

Licensed Practical Nurse

NPI 1013374313

Licensed Practical Nurse

Elideth O'dell

Social Worker - Clinical

NPI 1013407436
Dr. Travon Johnson , PsyD

Psychologist - Clinical

NPI 1013541192

Doctor of Psychology (Psy.D.)

Career & Practice History Timeline

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

13 Historical Events
📍
Updated Practice Location May 07, 2025

Registered at 9040 JACKSON AVE, TACOMA, WA 984319098 (Tel: 2539681110)

📍
Updated Business Mailing Address May 07, 2025

Registered at 9040 JACKSON AVE, TACOMA, WA 984310001

👤
Provider Name / Credentials Updated May 07, 2025

Recorded as NICHOLAS CLARK, DO

📍
Updated Practice Location May 24, 2024

Registered at 4430 MISSOURI AVE, FORT LEONARD WOOD, MO 654739098 (Tel: 8008742273)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 24, 2024

Pediatrics (License #0102207074 in VA)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 16, 2023

Student in an Organized Health Care Education/Training Program

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 19, 2022

Pediatrics (License #0102207074 in VA)

NPI Profile Active March 20, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location March 20, 2020

Registered at 3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 782344504 (Tel: 2102207638)

📍
Updated Business Mailing Address March 20, 2020

Registered at 3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 782344504 (Tel: 2102207638)

👤
Provider Name / Credentials Updated March 20, 2020

Recorded as NICHOLAS CLARK

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 20, 2020

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration March 20, 2020

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: 1740816842
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 20, 2020
Last Update: May 07, 2025
Sole Proprietor: No

Mailing Address

9040 Jackson Ave

Tacoma, WA 984310001

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

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.