Healthcare Provider Details

I. General information

NPI: 1760418131
Provider Name (Legal Business Name): NANCY CLEARKIN GERMANY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 FAIRFIELD AVE
SHREVEPORT LA
71101-4431
US

IV. Provider business mailing address

1860 FAIRFIELD AVE
SHREVEPORT LA
71101-4431
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-1313
  • Fax: 318-675-1319
Mailing address:
  • Phone: 318-675-1313
  • Fax: 318-675-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number020120
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: