MEDICARE: ANDREW CLARK CRNP

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	363LF0000X	Family Nurse Practitioner	SP029864	PA

General Provider Information

NPI Number	:	1609382670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CLARK CRNP

Provider Business Mailing Address
First Line	:	2605 WILLOW STREET PIKE N
Second Line	:
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9510
Country	:	US
Telephone Number	:	717-464-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 WILLOW STREET PIKE N
Second Line	:
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9510
Country	:	US
Telephone Number	:	717-464-2838
Fax Number	:

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

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	05/13/2026

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