Provider Demographics
NPI:1346087764
Name:CLARK, KATELYNN (DNP-FNP)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CABINET SHOP RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8963
Mailing Address - Country:US
Mailing Address - Phone:910-785-5351
Mailing Address - Fax:
Practice Address - Street 1:114 CABINET SHOP RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8963
Practice Address - Country:US
Practice Address - Phone:910-785-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF07240676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily