Provider Demographics
NPI:1851383962
Name:CLARK, KAREN COX (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:COX
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 MALCOLM BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:CONNELLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28612-8079
Mailing Address - Country:US
Mailing Address - Phone:828-874-4600
Mailing Address - Fax:828-874-8900
Practice Address - Street 1:730 MALCOLM BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CONNELLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612-8079
Practice Address - Country:US
Practice Address - Phone:828-874-4600
Practice Address - Fax:828-874-8900
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851383962Medicaid
MC0114950OtherDEA NO.