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General NPI Number Information
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NPI Number | 1073294708
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Entity Type | Individual
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Provider Name | MELANIE CLARKE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 2225 PORTLAND ST
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-8635
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Country | US
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Telephone | 802-748-3181
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MULBERRY LN UNIT 201
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City | BURLINGTON
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State | VT
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Zip | 05401-5898
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Country | US
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Telephone | 860-707-3903
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0136382
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License Number State | VT
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