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NPI Code Detail

MEDICARE: YVONNE Y. CLARK CNP

MEDICARE: YVONNE Y. CLARK CNP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.07925OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710963657
Entity Type Code : Individual
Provider Name (Legal Business Name) : YVONNE Y. CLARK CNP
Provider Business Mailing Address
First Line : 1550 YANKEE PARK PL
Second Line : STE A
City : CENTERVILLE
State : OH
Zip : 45458-1838
Country : US
Telephone Number : 937-439-4949
Fax Number : 937-439-4948
Provider Business Practice Location Address
First Line : 6300 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45415-3154
Country : US
Telephone Number : 937-275-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 05/02/2024

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