Individual
DEBRA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1040 VINEHAVEN DR NE, CONCORD, NC 28025-2438
(704) 784-1010
(704) 784-1013
Mailing address
1040 VINEHAVEN DR NE, CONCORD, NC 28025-2438
(704) 784-1010
(704) 784-1013
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5007863
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
5007863
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336525625
—
NC
Enumeration date
08/10/2015
Last updated
08/02/2024
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