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General NPI Number Information
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NPI Number | 1467723668
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Entity Type | Individual
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Provider Name | RONALD BRANDON CLARK FNP
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Gender | Male
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 971 ROBERT BLVD
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City | SLIDELL
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State | LA
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Zip | 70458-2009
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Country | US
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Telephone | 985-690-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 162 TCHEFUNCTE PARC DR
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City | MADISONVILLE
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State | LA
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Zip | 70447-9759
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Country | US
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Telephone | 985-351-3553
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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 | R851752
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License Number State | MS
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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 | AP07081
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License Number State | LA
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