Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Shannon Joan Clark, AGNPRN

Individual provider Nurse Practitioner · NPI 1508299777

MS. Shannon Joan Clark, AGNPRN is a Nurse Practitioner in Raleigh, North Carolina. Qualified in 2013, 13 years ago. Practices with North Carolina Nephrology PA, a 58-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
13
Licensed in
NC
In the registry since
2013
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Practice location Address checks out

3700 Barrett Dr Ste 200
Raleigh, NC 27609-7172
Phone: (919) 231-3966
Fax: (919) 231-3912
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 5006374 (NC)

Record details

NPI number1508299777
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGNPRN
Sole proprietorNo
NPI enumeratedAugust 12, 2013
Last updated in NPPESFebruary 12, 2025
Certification dateFebruary 12, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice North Carolina Nephrology Pa — 58 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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