Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 22594 | SC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 22594 | SC |
NPI | 1003371931 |
---|---|
Provider Name | June Taylor Clark |
First Address | West Columbia, SC 29169 |
Second Address | West Columbia, SC 29169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 07/06/2019 |