MEDICARE: KAREN COX 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
1	363LF0000X	Family Nurse Practitioner	200660	NC
2	363LF0000X	Family Nurse Practitioner	4003	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1851383962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN COX CLARK FNP

Provider Business Mailing Address
First Line	:	817 10TH AVE S
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-3222
Country	:	US
Telephone Number	:	843-839-7283
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 10TH AVE S
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-3222
Country	:	US
Telephone Number	:	843-839-7283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	01/26/2025

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