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NPI Code Detail

MEDICARE: BEVERLY ANNE-MARIE CLARK CRNA

MEDICARE: BEVERLY ANNE-MARIE CLARK CRNA
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
1367500000XCertified Registered Nurse Anesthetist5313NC
2174400000XSpecialist3527951NY
3367500000XCertified Registered Nurse Anesthetist352795NY

General Provider Information

NPI Number : 1770583924
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY ANNE-MARIE CLARK CRNA
Provider Business Mailing Address
First Line : 13808 PROFESSIONAL CENTER DR
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7948
Country : US
Telephone Number : 704-377-4009
Fax Number :
Provider Business Practice Location Address
First Line : 13808 PROFESSIONAL CENTER DR
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7948
Country : US
Telephone Number : 704-377-4009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 10/29/2025

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Directions to “ BEVERLY ANNE-MARIE CLARK CRNA” Practice Location

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