Doctor Name: | DOLORES E CLARK |
NPI Number: | 1114122348 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PNP |
License Number: | 211820 |
Business Practice Address: | 3801 William D Tate Ave Ste 200 Grapevine, TX - 760518755 |
Business Phone Number: | 8174166644 |
Business Fax Number: | 8174242882 |
Mailing Address: | Po Box 99371, FORT WORTH |
State: | TX |
Postal Code: | 761990371 |
Phone Number: | 6828851855 |
Fax Number: | 6828857347 |
NPI Enumeration Date: | 06/18/2007 |
NPI Last Update Date: | 04/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 211820 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |