NPI 1407903693 · live from the CMS NPI Registry
Mark Allen Clark
Nurse Practitioner, Pediatrics in Fredericksburg, VA. National Provider Identifier 1407903693, active.
NPI record
| NPI | 1407903693 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 111 Park Hill Dr # A, Fredericksburg, VA 22401 |
| Practice phone | 540-368-1044 |
| Mailing address | 22445 Conservancy Dr, Ashburn, VA 20148 |
| Enumerated | January 3, 2007 |
| Last updated | November 7, 2012 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 0024166868 (VA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.