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NPI Code Detail

MEDICARE: KAREN SHEPARD CLARK RN, MS, CRNP, ACHPN

MEDICARE: KAREN SHEPARD CLARK RN, MS, CRNP, ACHPN
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
1363L00000XNurse PractitionerTP003017HPA

General Provider Information

NPI Number : 1073581518
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN SHEPARD CLARK RN, MS, CRNP, ACHPN
Provider Business Mailing Address
First Line : 1111 E END BLVD
Second Line :
City : WILKES BARRE
State : PA
Zip : 18711-0030
Country : US
Telephone Number : 570-888-6803
Fax Number : 570-888-2025
Provider Business Practice Location Address
First Line : 1111 E END BLVD
Second Line :
City : WILKES BARRE
State : PA
Zip : 18711-0030
Country : US
Telephone Number : 570-888-6803
Fax Number : 570-888-2025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 02/16/2022

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