Clark, Andrea

Clark, Andrea is an individual health care provider with primary practice located at 1919 E Thomas Rd , Phoenix AZ 85016-7710. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Clark, Andrea can be contacted via phone (602) 933-1900.

Contact Information

Primary practice address
1919 E Thomas Rd Phoenix AZ 85016-7710
Phone: (602) 933-1900
Fax: (602) 933-1918
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 264063 Arizona

Profile Details

NPI number 1295457364
LBN Legal business name Clark, Andrea
Credentials PNP- PC/AC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2022
Last updated Jun 21st, 2024 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295457364 NPPES
Arizona MEDICAID 156185

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