Individual
MR. CASEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
815 OBERLIN RD, RALEIGH, NC 27605-1300
(630) 740-0574
Mailing address
311 MCDOWELL DR, WAKE FOREST, NC 27587-2572
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
647396
NY
163W00000X
Registered Nurse
9295142
FL
363L00000X
Nurse Practitioner
50100977
NC
363L00000X
Nurse Practitioner
Primary
ARNP9295142
FL
390200000X
Student in an Organized Health Care Education/Training Program
647396
NY
Other
Enumeration date
07/13/2013
Last updated
03/11/2019
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