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General NPI Number Information
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NPI Number | 1043851645
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Entity Type | Individual
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Provider Name | WHITNEY CLARK AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 319 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3124
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Country | US
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Telephone | 936-634-3713
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Fax |
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Provider Business Mailing Address
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Address Line | 440 GUY YORK RD
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City | LUFKIN
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State | TX
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Zip | 75901-1777
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Country | US
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Telephone | 936-581-6029
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Fax | 936-634-8136
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP143273
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License Number State | TX
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