Healthcare Provider Details

I. General information

NPI: 1851383962
Provider Name (Legal Business Name): KAREN COX CLARK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/26/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 10TH AVE S
SURFSIDE BEACH SC
29575-3222
US

IV. Provider business mailing address

817 10TH AVE S
SURFSIDE BEACH SC
29575-3222
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-7283
  • Fax:
Mailing address:
  • Phone: 843-839-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200660
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4003
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: