Provider Demographics
NPI:1255835922
Name:CLARKE, SHAREE S (NP)
Entity Type:Individual
Prefix:
First Name:SHAREE
Middle Name:S
Last Name:CLARKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3065 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5361
Practice Address - Country:US
Practice Address - Phone:888-708-0561
Practice Address - Fax:404-585-2688
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61228348363LF0000X
DCRN1057623363LF0000X
IL277002059363LF0000X
NC5018576363LF0000X
SC27838363LF0000X
NY831093363LF0000X
GARN244132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily