Clark, Debra
Clark, Debra is an individual health care provider with primary practice located at 1040 Vinehaven Dr Ne , Concord NC 28025-2438. 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, Debra can be contacted via phone (704) 784-1010.Contact Information
Primary practice address
1040 Vinehaven Dr Ne
Concord NC 28025-2438
Phone: (704) 784-1010
Fax: (704) 784-1013
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 5007863 | North Carolina |
Profile Details
| NPI number | 1336525625 |
|---|---|
| LBN Legal business name | Clark, Debra |
| Credentials | Pediatric Nurse Practitioner (PNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 10th, 2015 |
| Last updated | Jul 21st, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336525625 | NPPES |
| North Carolina | MEDICAID | 1336525625 |
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