Provider Demographics
NPI:1215117593
Name:CLARK, PONTRIS SAPP (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:PONTRIS
Middle Name:SAPP
Last Name:CLARK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:PONTRESS
Other - Middle Name:DENISE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6308 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:N RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-0832
Mailing Address - Country:US
Mailing Address - Phone:817-676-4011
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:800-561-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX465762363LA2200X
TXA1007111363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health