Meredith Renae Clark
Nurse Practitioner Nurse Practitioner - Gerontology
605 Cotton St
Winston Salem
, North Carolina 27101-5080
Meredith Renae Clark
Nurse Practitioner Nurse Practitioner - Gerontology
605 Cotton St
Winston Salem
, North Carolina 27101-5080
(336) 716-2255
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About
Features
Specialties
- Nurse Practitioner
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Meredith Renae Clark
- Medical Center Blvd
- Winston Salem, NC
- Zip : 27157-0001
- Phone : (336) 716-2255
Second Address
- Meredith Renae Clark
- 605 Cotton St
- Winston Salem, NC
- Zip : 27101-5080
- Phone : (336) 716-2255
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Is Meredith Renae Clark a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 3999-33 | WI |
| Y | 363L00000X | Nurse Practitioner | 5010316 | NC |
| N | 363LG0600X | Nurse Practitioner - Gerontology | 3999 | WI |
National Provider Identifier
| NPI | 1063735504 |
|---|---|
| Provider Name | Meredith Renae Clark |
| First Address | Winston Salem, NC 27157-0001 |
| Second Address | Winston Salem, NC 27101-5080 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 11/03/2010 |
| Last Update Date | 05/04/2018 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.