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NPI Code Detail

MEDICARE: MRS. CYNTHIA ANNE CLARK F.N.P.

MEDICARE: MRS. CYNTHIA ANNE CLARK F.N.P.
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 Practitioner200746NC
2363LF0000XFamily Nurse Practitioner200746NC

General Provider Information

NPI Number : 1295824910
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CYNTHIA ANNE CLARK F.N.P.
Provider Business Mailing Address
First Line : 5221 PARAMOUNT PKWY STE 220
Second Line :
City : MORRISVILLE
State : NC
Zip : 27560-5490
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2934 N ELM ST STE B
Second Line :
City : LUMBERTON
State : NC
Zip : 28358-2987
Country : US
Telephone Number : 910-272-1175
Fax Number : 910-272-1176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 03/05/2024

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