NPI age
19 years
Enumerated 2006-08-30
● Active
Type 1 · Individual
Timothy Michael Clark, CRNA
Clark is 1 of 110 nurse anesthetist, certified registered providers in Tyler and 1 of 6676 in Texas.
Primary specialty
Nurse Anesthetist, Certified Registered
Licensed in
TX
1 state
Status
Active
No deactivations on record
Last NPPES update
2017-10-23
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 6676 active nurse anesthetist, certified registered providers in Texas.
NPI age
19 years
↑ 6 yr above median (13 yr)
State licenses
1 state
16% of peers hold multiple states
Subspecialties
0
35% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-08Enumerated in NPPES
2006
2026
Where they practice
Practice location
800 E Dawson St
Tyler, TX 757012036
Mailing address
Po Box 841656
Dallas, TX 752841656
Specialties
-
Nurse Anesthetist, Certified Registered Primary(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 183309707 | |
| 01 (TX) | 75-0976930-005 | TRICARE |
| 01 (TX) | P01877259 | MEDICARE RAIL ROAD |
| 05 (TX) | 183309702 | |
| 01 | 75-2771569-008 | TRICARE |
| 05 (TX) | 183309703 | |
| 01 (TX) | 88839U | BCBS |
| 05 (TX) | 138309701 | |
| 01 (TX) | P01246269 | RAIL ROAD |
| 01 (TX) | 86167U | BCBS |
Practice context
Part of a multi-provider practice. 321 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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