Provider Demographics
NPI:1326810946
Name:CLARK, ARNETTA
Entity Type:Individual
Prefix:
First Name:ARNETTA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10822 WALDEN FERRY RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-2409
Mailing Address - Country:US
Mailing Address - Phone:318-404-9736
Mailing Address - Fax:
Practice Address - Street 1:10822 WALDEN FERRY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:LA
Practice Address - Zip Code:71033-2409
Practice Address - Country:US
Practice Address - Phone:318-404-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty