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NPI Code Detail

MEDICARE: ELISE N. CLARK FNP

MEDICARE: ELISE N. 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 PractitionerAP128458TX

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 : 1962885145
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISE N. CLARK FNP
Provider Business Mailing Address
First Line : 5473 BLAIR RD STE 100
Second Line :
City : DALLAS
State : TX
Zip : 75231-4227
Country : US
Telephone Number : 972-850-0687
Fax Number :
Provider Business Practice Location Address
First Line : 5473 BLAIR RD STE 100
Second Line :
City : DALLAS
State : TX
Zip : 75231-4227
Country : US
Telephone Number : 972-850-0687
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2015
Last Update Date : 10/21/2024

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