Provider Demographics
NPI:1457993677
Name:CLARK, ASHLEY T (FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:T
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CORPORATE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7428
Mailing Address - Country:US
Mailing Address - Phone:843-698-3120
Mailing Address - Fax:888-900-2640
Practice Address - Street 1:2050 CORPORATE CENTRE DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7428
Practice Address - Country:US
Practice Address - Phone:843-698-3120
Practice Address - Fax:888-900-2640
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily