| Organization Name: | CAROLYN CLARK FNP LLC |
| NPI Number: | 1134500739 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAROLYN CLARK (OWNER) |
| Mailing Address: | 1232 Branson Hills Pkwy Ste 106 Branson |
| State: | MO US |
| Postal Code: | 656164189 |
| Phone Number: | 4173323639 |
| Fax Number: | 4173323641 |
| NPI Enumeration Date: | 06/09/2015 |
| NPI Last Update Date: | 06/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2013024407 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |