Healthcare Provider Details

I. General information

NPI: 1245781285
Provider Name (Legal Business Name): ASHLEY CLARK MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HOSPITAL DR
CLARION PA
16214-8502
US

IV. Provider business mailing address

2 HOSPITAL DR
CLARION PA
16214-8502
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-9545
  • Fax:
Mailing address:
  • Phone: 814-226-9545
  • Fax: 724-548-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016644
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: