CAROLYN CLARK FNP LLC NPI 1134500739

NPI Information

NPI: 1134500739
Provider Name: CAROLYN CLARK FNP LLC

Doing Business As: TRI-LAKES FAMILY CARE

Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
1232 BRANSON HILLS PKWY STE 106
BRANSON, MO
ZIP 65616
Phone: (417) 332-3639
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CAROLYN CLARK FNP LLC is a family nurse practitioner in Branson, MO. CAROLYN CLARK FNP LLC NPI is 1134500739. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Tri-lakes Family Care.

The provider's business location address is:

1232 BRANSON HILLS PKWY STE 106
BRANSON, MO
ZIP 65616-189
Phone: (417) 332-3639
Fax: (417) 332-3641

The provider's authorized official is Carolyn Clark .
The authorized official title is Owner and has the following contact phone number (417) 332-3639.

The CLIA number assigned to this NPI record is 26D2103211 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/9/2015 and was last updated on 6/9/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	2013024407	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1679915664	OTHER	MISSOURI	NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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