Individual
REBECCA S. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
10600 INDUSTRIAL DR, MINDEN, LA 71055-5105
(318) 798-4616
(318) 798-4619
Mailing address
1455 E BERT KOUN LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4539
(318) 798-4601
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP05233
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1362484
—
LA
Enumeration date
08/17/2007
Last updated
04/10/2017
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