Provider Demographics
NPI:1699395756
Name:CLARK, KARRIANN MELISSA (LPN)
Entity Type:Individual
Prefix:
First Name:KARRIANN
Middle Name:MELISSA
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KARRIANN
Other - Middle Name:MELISSA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 COUNTY RD # A
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-1214
Mailing Address - Country:US
Mailing Address - Phone:774-208-7979
Mailing Address - Fax:
Practice Address - Street 1:226 COUNTY RD # A
Practice Address - Street 2:
Practice Address - City:EAST FREETOWN
Practice Address - State:MA
Practice Address - Zip Code:02717-1214
Practice Address - Country:US
Practice Address - Phone:774-208-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN68353164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse