{"npi":"1295457364","type":"NPI-1","status":"active","name":{"display":"Andrea Clark Pnp- PC/Ac","other":[],"first":"ANDREA","last":"CLARK","credential":"PNP- PC/AC"},"specialty":{"primary_taxonomy":"363LP0200X","primary_taxonomy_description":"Nurse Practitioner, Pediatrics","slug":"nurse-practitioner-pediatrics","schema_org_specialty":"Pediatric","all":[{"code":"363LP0200X","description":"Nurse Practitioner, Pediatrics","primary":true,"state":"AZ","license":"264063"}]},"addresses":[{"purpose":"LOCATION","street_1":"1919 E THOMAS RD","city":"PHOENIX","state":"AZ","postal_code":"850167710","country_code":"US","phone":"6029331900","fax":"6029331918"},{"purpose":"MAILING","street_1":"2108 E THOMAS RD STE 130","city":"PHOENIX","state":"AZ","postal_code":"850160008","country_code":"US","phone":"6029331813"}],"license":{"state":"AZ","number":"264063"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"156185","state":"AZ","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20221219001674","type_code":"14-50","type_desc":"PRACTITIONER - NURSE PRACTITIONER","state":"AZ","pac_id":"5597134296"}]},"enumeration_date":"2022-09-15","last_updated":"2024-06-21","_meta":{"source":"NPPES","snapshot_date":"2024-06-21","doc_url":"https://findmynpi.com/api"}}