Individual
STACEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4 CRESCENT ST., PENACOOK, NH 03303-1412
(603) 753-4302
(603) 227-7570
Mailing address
4 CRESCENT ST, PENACOOK, NH 03303-1412
(603) 753-4302
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0622
NH
363AM0700X
Medical Physician Assistant
2511
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3073660
—
NH
Enumeration date
11/08/2005
Last updated
09/30/2022
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