Provider Demographics
NPI:1114029238
Name:CLARK, LAURA KAY (FNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KAY
Other - Last Name:CLARK-BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC, APRN
Mailing Address - Street 1:#4 HOSPITAL DRIVE
Mailing Address - Street 2:ST. VINCENT MORRILTON HOSPITAL
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4510
Mailing Address - Country:US
Mailing Address - Phone:501-977-2300
Mailing Address - Fax:770-874-5483
Practice Address - Street 1:#4 HOSPITAL DRIVE
Practice Address - Street 2:ST. VINCENT MORRILTON HOSPITAL
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4510
Practice Address - Country:US
Practice Address - Phone:501-977-2300
Practice Address - Fax:501-977-2341
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117992003Medicaid
AR117992003Medicaid