=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972375194
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA DAWN CLARK MSN, APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2023
-----------------------------------------------------
Last Update Date | 02/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3800 GAYLORD PKWY STE 780
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-8417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-430-0511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1750 COUNTY ROAD 139
-----------------------------------------------------
City | HUTTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78634-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-909-2363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1141110
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------