Provider Demographics
NPI:1245656958
Name:CLARK, CHIMERE L (WHNP)
Entity type:Individual
Prefix:
First Name:CHIMERE
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1914
Mailing Address - Country:US
Mailing Address - Phone:757-446-7920
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-446-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017141498363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10129497NOtherOPTIMA HEALTH
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VA-010OtherTRICARE/CHAMPUS
VA1245656958OtherVIRGINIA PREMIER HEALTH PLAN
VA1245656958Medicaid
VAPAROtherUSA MANAGED CARE
NC1245656958Medicaid
VAPAROtherCORVEL