Provider Demographics
NPI:1265220933
Name:MUNN, CLARKIE
Entity type:Individual
Prefix:
First Name:CLARKIE
Middle Name:
Last Name:MUNN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4984 BLUE BANKS LOOP RD NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-8950
Mailing Address - Country:US
Mailing Address - Phone:919-723-0253
Mailing Address - Fax:
Practice Address - Street 1:4984 BLUE BANKS LOOP RD NE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-8950
Practice Address - Country:US
Practice Address - Phone:919-723-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC372500000X, 347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)