Healthcare Provider Details

I. General information

NPI: 1518855972
Provider Name (Legal Business Name): HEATHER LYNN CLARK DNP, RN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 FOX LN
EMMAUS PA
18049-4837
US

IV. Provider business mailing address

5524 FOX LN
EMMAUS PA
18049-4837
US

V. Phone/Fax

Practice location:
  • Phone: 610-390-3278
  • Fax: 610-390-3278
Mailing address:
  • Phone: 610-390-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP033049
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: