MEDICARE: KARLEY CLARK APRN, MSN, FNP-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	363LF0000X	Family Nurse Practitioner	908068	MS

General Provider Information

NPI Number	:	1861340226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLEY CLARK APRN, MSN, FNP-C

Provider Business Mailing Address
First Line	:	11700 HIGHWAY 57
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-8309
Country	:	US
Telephone Number	:	228-826-1482
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 HIGHWAY 57
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-8309
Country	:	US
Telephone Number	:	228-826-1482
Fax Number	:

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

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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