Individual
MR. CLARENCE DAVID RUNNELS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
523 KEISLER DR STE 202, CARY, NC 27518-7099
(919) 601-6442
Mailing address
523 KEISLER DR, CARY, NC 27518-7099
(919) 601-6442
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5011070
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018010871
ANCC CERTIFICATION NUMBER
NC
01
—
5011070
NCBON LICENSE NUMBER
NC
Enumeration date
10/03/2018
Last updated
12/04/2024
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