Clark, Carol

Clark, Carol is an individual health care provider with primary practice located at 9015 E 17Th St , Indianapolis IN 46229-2016. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Community Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Clark, Carol can be contacted via phone (317) 898-3166.

Contact Information

Primary practice address
9015 E 17Th St Indianapolis IN 46229-2016
Phone: (317) 898-3166
Fax: (317) 898-4219
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Community Health 363LC1500X 71000959A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 71000959A Indiana

Profile Details

NPI number 1770535502
LBN Legal business name Clark, Carol
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated May 2nd, 2012 - about 13 years 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 1770535502 NPPES
Indiana MEDICAID 200307710
Indiana Other P01016729

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