Provider Demographics
NPI:1972129195
Name:CLARK, ADRIENNE JENKINS (APRN-C)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:JENKINS
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN-C
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 627
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-0627
Mailing Address - Country:US
Mailing Address - Phone:225-335-4085
Mailing Address - Fax:
Practice Address - Street 1:10053 FLORIDA BLVD UNIT 627
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-5097
Practice Address - Country:US
Practice Address - Phone:225-335-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily