Provider Demographics
NPI:1578779880
Name:CLARKE, CAROL ANN (FNP)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0189
Mailing Address - Country:US
Mailing Address - Phone:910-862-6900
Mailing Address - Fax:910-862-6859
Practice Address - Street 1:300 MERCER MILL RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-3959
Practice Address - Country:US
Practice Address - Phone:910-862-6900
Practice Address - Fax:910-862-6859
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner