Provider Demographics
NPI:1922668904
Name:CLARK, BOBBI S (AGNP)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8748
Mailing Address - Country:US
Mailing Address - Phone:910-715-3500
Mailing Address - Fax:910-715-3501
Practice Address - Street 1:220 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8748
Practice Address - Country:US
Practice Address - Phone:910-715-3500
Practice Address - Fax:910-715-3501
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011909363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health