CLARK R. GWALTNEY DNP-PACNP, RNFA, CPN
NPI 1922771195
Nurse Practitioner - Pediatrics in Memphis, TN
About Clark R. Gwaltney Dnp-pacnp, Rnfa, Cpn NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CLARK R. GWALTNEY DNP-PACNP, RNFA, CPN (NPI 1922771195) is an individual pediatrics provider in Memphis, Tennessee, licensed in Tennessee (29917) and active in the NPI registry since July 2021. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Clark R. Gwaltney Dnp-pacnp, Rnfa, Cpn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Clark Gwaltney reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Memphis, TN 38105
- Reassigned Medicare billing, Tennessee enrollment
- Medicare enrollment name: St Jude Childrens Research Hospital Inc
- 367 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 38105 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
MEMPHIS, TN 38105
MEMPHIS, TN 38105
MEMPHIS, TN 38105
MEMPHIS, TN 38105
MEMPHIS, TN 38105
MEMPHIS, TN 38105
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Clark Gwaltney's NPI number?
The NPI number for Clark Gwaltney is 1922771195. It was assigned to this individual provider in the NPPES registry on July 26, 2021.
Where is Clark Gwaltney located?
Clark Gwaltney practices at 262 Danny Thomas Pl, Memphis, TN 38105. The listed phone number is (901) 595-3300.
What is Clark Gwaltney's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Clark Gwaltney enrolled in Medicare?
Yes. Clark Gwaltney is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Clark Gwaltney's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Clark Gwaltney reassigns Medicare benefits to St Jude Children's Research Hospital, Inc. (Memphis, TN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Clark Gwaltney's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Clark Gwaltney was last updated on December 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Clark R. Gwaltney, DNP-PACNP, RNFA, CPN · NPI 1922771195
Pediatrics physician in Memphis, Tennessee. Individual provider, active in the CMS NPPES registry since July 26, 2021.
## Identity
- **NPI:** 1922771195 (Entity type: Individual)
- **Enumerated:** July 26, 2021
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **State license:** 29917 (Tennessee)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 262 DANNY THOMAS PL, Memphis, TN 38105-3678
- **Phone:** (901) 595-3300
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** St Jude Children's Research Hospital, Inc. (NPI 1306335088, Memphis, TN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 10, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1922771195) · Data from the CMS NPPES public registry.