Provider Demographics
NPI:1013657352
Name:CLARKE, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:RENEE
Other - Last Name:AKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1176 ACKISON ST
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1176 ACKISON ST
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:KY
Practice Address - Zip Code:41169-1923
Practice Address - Country:US
Practice Address - Phone:606-833-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY123661133V00000X
OHLD.5351133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered