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General NPI Number Information
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NPI Number | 1497708572
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Entity Type | Individual
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Provider Name | BENJAMIN S CLARK FNP
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 108C MCMEANS AVE
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City | BAY MINETTE
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State | AL
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Zip | 36507-3130
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Country | US
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Telephone | 251-445-3391
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Fax | 251-445-3722
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Provider Business Mailing Address
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Address Line | 108C MCMEANS AVE
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City | BAY MINETTE
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State | AL
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Zip | 36507-3130
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Country | US
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Telephone | 251-445-3391
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Fax | 251-445-3722
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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 | 1-098021
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License Number State | AL
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