Provider Demographics
NPI:1578931655
Name:CLARK, BRITTANY (CFNP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:N
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:474 W BANKHEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3319
Mailing Address - Country:US
Mailing Address - Phone:662-840-4577
Mailing Address - Fax:
Practice Address - Street 1:474 W BANKHEAD ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3319
Practice Address - Country:US
Practice Address - Phone:662-419-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR886803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily