Provider Demographics
NPI:1083497986
Name:CLARKE-DAVIS, CHARMAINE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:
Last Name:CLARKE-DAVIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3480
Mailing Address - Fax:607-547-4838
Practice Address - Street 1:739 STATE HIGHWAY 28 STE 9
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3590
Practice Address - Country:US
Practice Address - Phone:607-431-1015
Practice Address - Fax:607-431-1050
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily