Individual
AMANDA NICHOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
1507 RIVERY BLVD, GEORGETOWN, TX 78628-3058
(512) 509-9550
(512) 509-9555
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
(254) 215-9722
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209030659
IL
363LF0000X
Family Nurse Practitioner
Primary
1215968
TX
363LF0000X
Family Nurse Practitioner
209.030659
IL
Other
Enumeration date
10/01/2024
Last updated
04/27/2026
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