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NPI Code Detail

MEDICARE: NANCY CLEARKIN GERMANY MD

MEDICARE: NANCY CLEARKIN GERMANY MD
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
1207Q00000XFamily Medicine Physician020120LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760418131
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY CLEARKIN GERMANY MD
Provider Business Mailing Address
First Line : 1860 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4431
Country : US
Telephone Number : 318-675-1313
Fax Number : 318-675-1319
Provider Business Practice Location Address
First Line : 1860 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4431
Country : US
Telephone Number : 318-675-1313
Fax Number : 318-675-1319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 07/14/2021

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