Provider Demographics
NPI:1700285327
Name:CLARK, BRITTANY KAY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:KAY
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 BELLEFONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9775
Mailing Address - Country:US
Mailing Address - Phone:419-739-1980
Mailing Address - Fax:419-739-1982
Practice Address - Street 1:1258 BELLEFONTAINE ST STE A
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895
Practice Address - Country:US
Practice Address - Phone:419-739-1980
Practice Address - Fax:419-739-1982
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16412-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH401061OtherMEDICARE PIN
OH0113150Medicaid