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NPI Code Detail

MEDICARE: JOANNE B CLARK FNP

MEDICARE: JOANNE B CLARK FNP
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
1363LF0000XFamily Nurse PractitionerAP127954TX

General Provider Information

NPI Number : 1407288475
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNE B CLARK FNP
Provider Business Mailing Address
First Line : 2022 MURCHISON
Second Line : SUITE 100
City : EL PASO
State : TX
Zip : 79902-3058
Country : US
Telephone Number : 915-533-5388
Fax Number : 915-533-0868
Provider Business Practice Location Address
First Line : 855 ANTHONY DR
Second Line :
City : ANTHONY
State : NM
Zip : 88021-9325
Country : US
Telephone Number : 575-882-5706
Fax Number : 575-882-2868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2013
Last Update Date : 09/15/2015

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