Provider Demographics
NPI:1033097787
Name:CLARK, COURTNEY E (FNP-BC, ARNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP-BC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674721
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4721
Mailing Address - Country:US
Mailing Address - Phone:515-643-2519
Mailing Address - Fax:515-461-9783
Practice Address - Street 1:2006 N 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-4500
Practice Address - Country:US
Practice Address - Phone:515-461-9784
Practice Address - Fax:515-461-9783
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA186336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily