# SHALITA CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1396214060
- **Gender:** F
- **Credential:** CRNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 1-147364 | AL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 402966V | NY | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 95010591 | CA | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | CV2100304 | IN | Yes |

## Other

- **Enumeration date:** 11/24/2018
- **Last updated:** 04/22/2022