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NPI Code Detail

MEDICARE: WHITNEY CLARK AGPCNP-BC

MEDICARE: WHITNEY CLARK AGPCNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse PractitionerAP143273TX

General Provider Information

NPI Number : 1043851645
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY CLARK AGPCNP-BC
Provider Business Mailing Address
First Line : 440 GUY YORK RD
Second Line :
City : LUFKIN
State : TX
Zip : 75901-1777
Country : US
Telephone Number : 936-581-6029
Fax Number : 936-634-8136
Provider Business Practice Location Address
First Line : 319 GASLIGHT BLVD
Second Line :
City : LUFKIN
State : TX
Zip : 75904-3124
Country : US
Telephone Number : 936-634-3713
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2019
Last Update Date : 11/27/2023

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Directions to “ WHITNEY CLARK AGPCNP-BC” Practice Location

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