MEDICARE: ANNIE PAIGE CLARK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10004591A	IN

General Provider Information

NPI Number	:	1336969328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE PAIGE CLARK PA-C

Provider Business Mailing Address
First Line	:	1100 SOUTHFIELD DR STE 1370
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-4300
Country	:	US
Telephone Number	:	317-837-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SOUTHFIELD DR STE 1140
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-4499
Country	:	US
Telephone Number	:	317-839-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	01/06/2026

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Directions to “ ANNIE PAIGE CLARK PA-C” Practice Location

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