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General NPI Number Information
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NPI Number | 1841682044
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Entity Type | Individual
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Provider Name | SAMANTHA CLARK NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 1505 CLINTON BUSINESS PARK DR
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City | CLINTON
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State | MS
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Zip | 39056-4443
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Country | US
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Telephone | 601-202-3965
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Fax | 601-510-9747
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Provider Business Mailing Address
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Address Line | 1505 CLINTON BUSINESS PARK DR
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City | CLINTON
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State | MS
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Zip | 39056-4443
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Country | US
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Telephone | 601-202-3965
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Fax | 601-510-9747
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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 | R874456
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License Number State | MS
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