Provider Demographics
NPI:1972497451
Name:CLARK, CARRIE ANN
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:CLARK
Suffix:
Gender:F
Credentials:
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 60
Mailing Address - Street 2:
Mailing Address - City:MOWRYSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45155-0060
Mailing Address - Country:US
Mailing Address - Phone:513-582-8942
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 34
Practice Address - Street 2:
Practice Address - City:MOWRYSTOWN
Practice Address - State:OH
Practice Address - Zip Code:45155-0034
Practice Address - Country:US
Practice Address - Phone:937-205-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty