Carolyn Clark, AC-CRNP-PMH in Carlsbad, CA - Medicare Nurse Practitioner

Carolyn Clark, AC-CRNP-PMH is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Carlsbad, California. Her current practice location is 6010 Hidden Valley Rd Ste 115, Carlsbad, California. You can reach out to her office (for appointments etc.) via phone at (760) 797-8494.

Carolyn Clark is licensed to practice in California (license number NP95013648) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1124429857.

Contact Information

	Carolyn Clark, AC-CRNP-PMH
	6010 Hidden Valley Rd Ste 115, Carlsbad, CA 92011-4219
	(760) 797-8494
	Not Available

Map and Direction

Provider's Profile

Full Name	Carolyn Clark
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	6010 Hidden Valley Rd Ste 115, Carlsbad, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1124429857
Provider Enumeration Date: 09/12/2014
Last Update Date: 09/03/2020

Medicare PECOS Information:

PECOS PAC ID: 4981915873
Enrollment ID: I20150618001925

Medical Identifiers

Medical identifiers for Carolyn Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1124429857	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	AC001401 (Maryland)	Secondary
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	NP95013648 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Carolyn Clark allows following entities to bill medicare on her behalf.

Entity Name	Hefuna Mental Health Wellness Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1629470547 PECOS PAC ID: 3577783240 Enrollment ID: O20141002000365

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Carolyn Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Carolyn Clark, AC-CRNP-PMH 2883 Demler Dr, Escondido, CA 92029-4815 Ph: () -	Carolyn Clark, AC-CRNP-PMH 6010 Hidden Valley Rd Ste 115, Carlsbad, CA 92011-4219 Ph: (760) 797-8494

Reviews and Comments

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Carolyn Clark, AC-CRNP-PMH - Medicare Nurse Practitioner in Carlsbad, CA