Provider Demographics
NPI:1215009758
Name:CLARK, CATHY GRIFFITTS (FNP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:GRIFFITTS
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP
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 369
Mailing Address - Street 2:200 HOSPITAL AVENUE, SUITE 3
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0369
Mailing Address - Country:US
Mailing Address - Phone:336-846-7433
Mailing Address - Fax:336-846-7878
Practice Address - Street 1:200 HOSPITAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-7433
Practice Address - Fax:336-846-7878
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC162V5OtherBCBSNC
NC7003870Medicaid
NC7003870Medicaid