Healthcare Provider Details

I. General information

NPI: 1245968049
Provider Name (Legal Business Name): MCKENSIE CLARK AARON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2134 DOUGLAS AVE
BREWTON AL
36426-1155
US

IV. Provider business mailing address

2134 DOUGLAS AVE
BREWTON AL
36426-1155
US

V. Phone/Fax

Practice location:
  • Phone: 251-236-4026
  • Fax: 251-270-4257
Mailing address:
  • Phone: 251-236-4026
  • Fax: 251-270-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-182878
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024197603
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP.AP.70132093-NP
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11047807
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-182878
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: