| Doctor Name: | MRS. BRENDA B CLARK |
| NPI Number: | 1417979576 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHYSICIANS ASSISTANT |
| License Number: | 100487 |
| Business Practice Address: | 371 Nc Hwy 65 Suite204 Rockingham Co. Dept Of Public Health Wentworth, NC - 273750204 |
| Business Phone Number: | 3363428140 |
| Business Fax Number: | 3363428356 |
| Mailing Address: | 371 Nc Hwy 65, Suite204 Rockingham Co. Dept Of Public Health WENTWORTH |
| State: | NC |
| Postal Code: | 273750204 |
| Phone Number: | 3363428140 |
| Fax Number: | 3363428356 |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 07/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 100487 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |