Provider Demographics
NPI: | 1760855456 |
---|---|
Name: | CLARK, DELANNA LEIGH (APRN) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DELANNA |
Middle Name: | LEIGH |
Last Name: | CLARK |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 120 ENTERPRISE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | DANVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40422-1870 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-236-2425 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3750 POPLAR CORNER RD |
Practice Address - Street 2: | |
Practice Address - City: | LEBANON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40033-9620 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-692-6336 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-11-04 |
Last Update Date: | 2023-08-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 3009843 | 363L00000X, 364SA2200X, 364SC1501X, 364SC2300X, 364SG0600X, 364SH0200X, 364SH1100X, 364SL0600X, 364SA2100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 364SA2100X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 364SA2200X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No | 364SC1501X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Community Health/Public Health |
No | 364SC2300X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Chronic Care |
No | 364SG0600X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
No | 364SH0200X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Home Health |
No | 364SH1100X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Holistic |
No | 364SL0600X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Long-Term Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100387970 | Medicaid |