Provider Demographics
NPI:1699184515
Name:CLARKE, TERRANCE ALAN (FNP)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:ALAN
Last Name:CLARKE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 30
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-644-0274
Practice Address - Street 1:CHP LEE FAMILY PRACTICE
Practice Address - Street 2:11 QUARRY HILL ROAD
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238
Practice Address - Country:US
Practice Address - Phone:413-243-0536
Practice Address - Fax:413-243-8040
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281720363LA2200X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110103952AMedicaid