Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Individual
TIMOTHY MICHAEL CLARK
Active
Individual
TIMOTHY MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
074887
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138309701
—
TX
05
—
183309702
—
TX
05
—
183309703
—
TX
05
—
183309707
—
TX
01
—
75-0976930-005
TRICARE
TX
01
—
75-2771569-008
TRICARE
—
01
—
86167U
BCBS
TX
01
—
88839U
BCBS
TX
01
—
P01246269
RAIL ROAD
TX
01
—
P01877259
MEDICARE RAIL ROAD
TX
Enumeration date
08/30/2006
Last updated
10/23/2017
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up