DR. KRISTIN MARIE CLARK MD
NPI 1083312904
General Practice in Tacoma, WA

Q: What is Kristin Clark's NPI number?

The NPI number for Kristin Clark is 1083312904. It was assigned to this individual provider in the NPPES registry on February 20, 2023.

Q: What is Kristin Clark's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Kristin Clark was last updated on November 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 20, 2023PECOS Enrolled

9040 JACKSON AVE, TACOMA, WA 98431(253) 968-3105 Get Directions Write a Review

NPPES record last updated: November 13, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 13, 2024, Aug 9, 2023, Feb 20, 2023 (3 updates tracked since 2023).

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About Dr. Kristin Marie Clark Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KRISTIN MARIE CLARK MD (NPI 1083312904) is an individual general practice provider in Tacoma, Washington, licensed in Virginia (0101284165) and active in the NPI registry since February 2023. She is enrolled in Medicare PECOS and maintains a secondary practice location in Seattle.

NPPES Registry Identity

NPI1083312904

Entity TypeIndividualFemale

Primary Taxonomy208D00000X

Provider Legal NameDR. KRISTIN MARIE CLARKCredential: MD

Location Address9040 JACKSON AVETacoma, WA 98431-0001

Mailing Address9040 Jackson AveTacoma, WA 98431-0001 · (253) 968-3105

Phone(253) 968-3105

Sole ProprietorNo

Enumeration DateFebruary 20, 2023

Last NPPES UpdateNovember 13, 20243 updates tracked since enumeration

NPPES CertifiedNovember 13, 2024

✔ NPI 1083312904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in VA · 0101284165

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedMilitary Health Care ProviderTaxonomy 171000000X

9040 JACKSON AVE, Tacoma, WA 98431

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Secondary Practice Location 1

Location 1325 9th AveSeattle, WA 98104-2499 · Phone (206) 744-3000

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kristin Marie Clark Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL JOHN MEANS CRNA

Nurse Anesthetist, Certified Registered