MEDICARE: KELLY ALEXA CLARKE ARNP

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	0024192849	VA
2	363LF0000X	Family Nurse Practitioner	ARNP9349079	FL
3	363LF0000X	Family Nurse Practitioner	1-185490	AL
4	363LF0000X	Family Nurse Practitioner	5021875	NC

General Provider Information

NPI Number	:	1922544766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ALEXA CLARKE ARNP

Provider Business Mailing Address
First Line	:	6350 CENTER DR STE 200
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-4107
Country	:	US
Telephone Number	:	757-905-5558
Fax Number	:	757-213-5762

Provider Business Practice Location Address
First Line	:	905 THUNDER RD STE 250
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7672
Country	:	US
Telephone Number	:	252-331-2044
Fax Number	:

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	07/17/2025

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