Provider Demographics
NPI:1114058203
Name:CLARK, BARBARA R (APRN FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:R
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:R
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:962 FOREST GLN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-8829
Mailing Address - Country:US
Mailing Address - Phone:770-231-8568
Mailing Address - Fax:678-489-2348
Practice Address - Street 1:962 FOREST GLN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-8829
Practice Address - Country:US
Practice Address - Phone:770-231-8568
Practice Address - Fax:678-489-2348
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128161163WR0006X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN128161OtherRN LICENSE