Healthcare Provider Details

I. General information

NPI: 1578402541
Provider Name (Legal Business Name): CAROLYN CLARK FNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 STATE HIGHWAY 248
BRANSON MO
65616-8398
US

IV. Provider business mailing address

1065 STATE HIGHWAY 248
BRANSON MO
65616-8398
US

V. Phone/Fax

Practice location:
  • Phone: 417-332-3639
  • Fax: 417-332-3641
Mailing address:
  • Phone: 417-332-3639
  • Fax: 417-332-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN GAY CLARK
Title or Position: OWNER
Credential:
Phone: 417-332-3639