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General NPI Number Information
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NPI Number | 1396226114
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Entity Type | Individual
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Provider Name | CATHERINE LYNN CLARK NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 2782 N COBB PKWY
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City | KENNESAW
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State | GA
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Zip | 30152-3472
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 2782 N COBB PKWY
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City | KENNESAW
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State | GA
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Zip | 30152-3472
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Country | US
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Telephone |
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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 | 5022918
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 31423
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 227661
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15518900
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024194712
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 124763
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License Number State | WV
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