MEDICARE: MRS. ANDREA DAWN CLARK MSN, APRN, FNP-C

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	1141110	TX

General Provider Information

NPI Number	:	1972375194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA DAWN CLARK MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1750 COUNTY ROAD 139
Second Line	:
City	:	HUTTO
State	:	TX
Zip	:	78634-5421
Country	:	US
Telephone Number	:	512-909-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 GAYLORD PKWY STE 780
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-8417
Country	:	US
Telephone Number	:	469-430-0511
Fax Number	:

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	02/17/2026

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