Provider Demographics
NPI:1265969356
Name:CLARK, AMY JO (APNP)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JO
Last Name:CLARK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1621 N TAYLOR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1993
Mailing Address - Country:US
Mailing Address - Phone:920-452-1650
Mailing Address - Fax:
Practice Address - Street 1:1621 N TAYLOR DR STE 100
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1993
Practice Address - Country:US
Practice Address - Phone:920-452-1650
Practice Address - Fax:920-452-3594
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI161099-30163W00000X
WI7806-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse