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Individual
CLARK CARROLL
Active
Individual
CLARK CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7914
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962773648
—
WI
Enumeration date
01/26/2012
Last updated
03/01/2021
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