SHANAVIER CLARK
NPI 1477044071
Social Worker in Gulfport, MS

Q: What is Shanavier Clark's NPI number?

The NPI number for Shanavier Clark is 1477044071. It was assigned to this individual provider in the NPPES registry on May 21, 2018.

Q: What is Shanavier Clark's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Q: When was this NPI record last updated?

The NPPES record for Shanavier Clark was last updated on November 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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 May 21, 2018PECOS EnrolledAccepts Medicare Assignment

15024 MARTIN LUTHER KING JR BLVD, GULFPORT, MS 39501(228) 864-0003(228) 863-7917 Get Directions Write a Review

NPPES record last updated: November 24, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 24, 2025, May 21, 2018 (2 updates tracked since 2018).

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About Shanavier Clark NPPES

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

SHANAVIER CLARK (NPI 1477044071) is an individual social worker in Gulfport, Mississippi, licensed in Mississippi (C11808) and active in the NPI registry since May 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1477044071

Entity TypeIndividualFemale

Primary Taxonomy104100000X

Provider Legal NameSHANAVIER CLARK

Location Address15024 MARTIN LUTHER KING JR BLVDGulfport, MS 39501-8306

Mailing Address10467 Corporate DrGulfport, MS 39503-4634 · (228) 374-2494 · Fax (228) 396-3457

Phone(228) 864-0003

Fax(228) 863-7917

Sole ProprietorYes

Medical School CMSOtherGraduated 2017

Enumeration DateMay 21, 2018

Last NPPES UpdateNovember 24, 20252 updates tracked since enumeration

NPPES CertifiedNovember 24, 2025

✔ NPI 1477044071 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers

Taxonomy Code104100000X

License✔ Licensed in MS · C11808

Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X

15024 MARTIN LUTHER KING JR BLVD, Gulfport, MS 39501

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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

Shanavier Clark 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 ID6002392503

PECOS Enrollment IDI20260114004034

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 18

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

COASTAL FAMILY HEALTH CENTER INC

Clinic/Center (Community Health)