Provider Demographics
NPI:1790900090
Name:CLARK, APRIL
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 US HIGHWAY 258 N
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-4385
Mailing Address - Country:US
Mailing Address - Phone:252-813-4055
Mailing Address - Fax:252-757-0663
Practice Address - Street 1:2932 BIRDSONG CIR
Practice Address - Street 2:
Practice Address - City:GRIMESLAND
Practice Address - State:NC
Practice Address - Zip Code:27837-9525
Practice Address - Country:US
Practice Address - Phone:252-717-7924
Practice Address - Fax:252-757-0663
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner