Provider Demographics
NPI:1992597850
Name:CLARK, ANITA JANE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:JANE
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 1:87 METZ LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLARE
Mailing Address - State:WV
Mailing Address - Zip Code:26408-7001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 METZ LN
Practice Address - Street 2:
Practice Address - City:MOUNT CLARE
Practice Address - State:WV
Practice Address - Zip Code:26408-7001
Practice Address - Country:US
Practice Address - Phone:304-838-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide