AMANDA NICHOLE CLARK DNP
NPI 1205654878
Nurse Practitioner - Family in Georgetown, TX

Q: What is Amanda Clark's NPI number?

The NPI number for Amanda Clark is 1205654878. It was assigned to this individual provider in the NPPES registry on October 1, 2024.

Q: What is Amanda Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Clark was last updated on April 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 October 01, 2024PECOS EnrolledAccepts Medicare Assignment

1507 RIVERY BLVD, GEORGETOWN, TX 78628(512) 509-9550(512) 509-9555 Get Directions Write a Review

NPPES record last updated: April 27, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 27, 2026, Jan 21, 2026, Dec 20, 2024 and 1 more (4 updates tracked since 2024).

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About Amanda Nichole Clark Dnp NPPES

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

AMANDA NICHOLE CLARK DNP (NPI 1205654878) is an individual family provider in Georgetown, Texas, licensed in Texas (1215968) and active in the NPI registry since October 2024. She is enrolled in Medicare PECOS, is affiliated with Northwestern Medicine Mchenry, and maintains a secondary practice location in Huntley.

NPPES Registry Identity

NPI1205654878

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameAMANDA NICHOLE CLARKCredential: DNP

Location Address1507 RIVERY BLVDGeorgetown, TX 78628-3058

Mailing AddressPo Box 844658Dallas, TX 75284-4658 · (800) 994-0371 · Fax (254) 215-9722

Phone(512) 509-9550

Fax(512) 509-9555

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateOctober 1, 2024

Last NPPES UpdateApril 27, 20264 updates tracked since enumeration

NPPES CertifiedApril 27, 2026

✔ NPI 1205654878 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Licenses✔ Licensed in TX · 1215968✔ Licensed in IL · 209.030659

Also ListedNurse PractitionerTaxonomy 363L00000X · License 209030659 (IL)

1507 RIVERY BLVD, Georgetown, TX 78628

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Secondary Practice Location 1

Location 110350 Haligus Rd Ste AHuntley, IL 60142-9545 · Phone (815) 455-6100 · Fax (847) 802-7162

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Amanda Nichole Clark Dnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6002340783

PECOS Enrollment IDI20260130003503

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.

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northwestern Medicine Mchenry

Acute Care Hospitals · Mchenry, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number140116

Location4201 Medical Center DriveMchenry, IL 60050 · Mc Henry County

Emergency services Birthing friendly

Northwestern Medicine Central Dupage Hospital

Acute Care Hospitals · Winfield, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140242

Location25 North Winfield RoadWinfield, IL 60190 · Du Page County

Emergency services Birthing friendly

Baylor Scott & White Medical Center - Round Rock

Acute Care Hospitals · Round Rock, TX

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number670034

Location300 University BlvdRound Rock, TX 78664 · Williamson County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78628 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.92 typical visit price

range $54.84 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.05 typical visit price

range $17.52 – $136.11

Typical copayment $24.26 (range $4.38 – $34.02)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

PAMELA PALMER APRN

Nurse Practitioner (Family)