Provider Demographics
NPI:1104121318
Name:CLARK, AMY BETH
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:WINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP-FNP
Mailing Address - Street 1:464 ALLEGHENY BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-6210
Mailing Address - Country:US
Mailing Address - Phone:866-962-3260
Mailing Address - Fax:
Practice Address - Street 1:5197 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-4807
Practice Address - Country:US
Practice Address - Phone:814-758-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily