MEDICARE: BRIYANA CLARK

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922935949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIYANA CLARK

Provider Business Mailing Address
First Line	:	600 IVY ROW NW APT 206
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3417
Country	:	US
Telephone Number	:	256-924-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 IVY ROW NW APT 206
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3417
Country	:	US
Telephone Number	:	256-924-6331
Fax Number	:

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “ BRIYANA CLARK ” Practice Location

Language	Start Address	Practice Location

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