Clark, Debra
Clark, Debra is an individual health care provider with primary practice located at 250 Charlois Blvd , Winston Salem NC 27103-1508. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Clark, Debra can be contacted via phone (336) 718-1000.Contact Information
Primary practice address
250 Charlois Blvd
Winston Salem NC 27103-1508
Phone: (336) 718-1000
Fax: (336) 718-1052
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 103316 | North Carolina |
Profile Details
| NPI number | 1720058282 |
|---|---|
| LBN Legal business name | Clark, Debra |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 25th, 2006 |
| Last updated | Apr 8th, 2016 - about 9 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 | 1720058282 | NPPES |
| North Carolina | MEDICAID | 8101696 |
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