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General NPI Number Information
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NPI Number | 1154131878
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Entity Type | Individual
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Provider Name | PATRICIA RENE CLERVIL CLARKE
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 545 E JOHN CARPENTER FWY STE 400
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City | IRVING
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State | TX
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Zip | 75062-8131
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Country | US
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Telephone | 888-523-8268
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Fax |
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Provider Business Mailing Address
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Address Line | 45 CHEEVER ST
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City | MILTON
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State | MA
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Zip | 02186-1126
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Country | US
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Telephone | 617-980-9921
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2343659
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License Number State | MA
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