Provider Demographics
NPI:1710295225
Name:CLARK, MEREDITH (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 RAVINES EDGE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5422
Mailing Address - Country:US
Mailing Address - Phone:614-304-3444
Mailing Address - Fax:614-304-3433
Practice Address - Street 1:8000 RAVINES EDGE CT STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5422
Practice Address - Country:US
Practice Address - Phone:614-304-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11696NP363LF0000X
OH11696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily