Healthcare Provider Details

I. General information

NPI: 1912414384
Provider Name (Legal Business Name): JULIE ANN CLARKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2169
LEXINGTON SC
29071-2169
US

IV. Provider business mailing address

619 AMBERWOOD RD
PICKENS SC
29671-8717
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-8496
  • Fax:
Mailing address:
  • Phone: 864-607-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number267045
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015286
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60825540
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201709775NP
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60825540
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25993
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201709775NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: