MEDICARE: LAUREN RACHEL 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	207QA0505X	Adult Medicine Physician	PA15281	TX
2	363A00000X	Physician Assistant	PA15281	TX

General Provider Information

NPI Number	:	1629606736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN RACHEL CLARK PA-C

Provider Business Mailing Address
First Line	:	2030 JAMAICA WAY
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-5181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 ROUTH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1414
Country	:	US
Telephone Number	:	214-296-0269
Fax Number	:

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	08/23/2022

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Directions to “ LAUREN RACHEL CLARK PA-C” Practice Location

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