Provider Demographics
NPI:1497415855
Name:CLARK, LINDSEY NICOLE (APRN CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:NICOLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WEST O STREET
Mailing Address - Street 2:DEAN HALL 126
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801
Mailing Address - Country:US
Mailing Address - Phone:479-968-0383
Mailing Address - Fax:
Practice Address - Street 1:345 STONE AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9309
Practice Address - Country:US
Practice Address - Phone:903-280-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124143363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics