| Doctor Name: | THERESA S CLARKE |
| NPI Number: | 1447446174 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 103209 |
| Business Practice Address: | 800 N Raleigh Street C1 Angier, NC - 275017547 |
| Business Phone Number: | 9193310031 |
| Business Fax Number: | 9193382627 |
| Mailing Address: | 800 N Raleigh St Ste C1, ANGIER |
| State: | NC |
| Postal Code: | 275018613 |
| Phone Number: | 9193310031 |
| Fax Number: | 9193382627 |
| NPI Enumeration Date: | 09/17/2007 |
| NPI Last Update Date: | 12/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 103209 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |