Healthcare Provider Details

I. General information

NPI: 1306260542
Provider Name (Legal Business Name): HOPE WAKEFIELD CLARY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4336 NORTH BLVD #201
BATON ROUGE LA
70806-3920
US

IV. Provider business mailing address

2051 SILVERSIDE DR SUITE 120
BATON ROUGE LA
70808-9005
US

V. Phone/Fax

Practice location:
  • Phone: 225-343-9505
  • Fax: 225-343-9141
Mailing address:
  • Phone: 225-490-8882
  • Fax: 225-765-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN122737AP07260
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: