# MR. CLARENCE DAVID RUNNELS III

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

## Provider details

- **NPI number:** 1487129649
- **Gender:** Man
- **Credential:** PMHNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 5011070 | NC | Yes |

## Other

- **Enumeration date:** 10/03/2018
- **Last updated:** 12/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2018010871 | ANCC CERTIFICATION NUMBER | NC |
| 01 | — | 5011070 | NCBON LICENSE NUMBER | NC |