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General NPI Number Information
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NPI Number | 1821469537
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Entity Type | Individual
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Provider Name | ALICIA CLARK FNP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1625 MEDICAL CENTER PT STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5748
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Country | US
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Telephone | 719-960-0363
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 MEDICAL CENTER PT STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5748
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Country | US
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Telephone | 719-960-0363
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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 | 2015030545
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License Number State | MO
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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 | 53-76985-042
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License Number State | KS
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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 | C-APN.0103064-C-NP
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License Number State | CO
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