Provider Demographics
NPI:1225852874
Name:CLARK, MEAGAN NICHOLE (CNA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:NICHOLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GINA CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-6073
Mailing Address - Country:US
Mailing Address - Phone:501-693-8608
Mailing Address - Fax:
Practice Address - Street 1:1011 GINA CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-6073
Practice Address - Country:US
Practice Address - Phone:501-693-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050543290615E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide