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General NPI Number Information
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NPI Number | 1194190579
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Entity Type | Individual
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Provider Name | MANET LEMUEL-CLARKE AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 7000 N MO PAC EXPY., SUITE 420
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City | AUSTIN
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State | TX
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Zip | 78731-3055
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Country | US
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Telephone | 512-482-0045
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 742616
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City | ATLANTA
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State | GA
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Zip | 30374-2616
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Country | US
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Telephone | 770-219-8420
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP015417
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN285594
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1191083
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License Number State | TX
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