DEANNA R CLARK CFNP NPI 1477003366

NPI Information

  • NPI: 1477003366
  • Provider Name: DEANNA R CLARK, CFNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4225 MONTGOMERY BLVD NE
    ALBUQUERQUE, NM
    ZIP 87109
  • Phone: (505) 366-3635

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NPI Details

Deanna R Clark, CFNP is a family nurse practitioner in Albuquerque, NM with 10 years of experience. Deanna R Clark, CFNP NPI is 1477003366. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4225 MONTGOMERY BLVD NE
ALBUQUERQUE, NM
ZIP 87109-103
Phone: (505) 366-3635
Fax: (505) 221-5429

The NPI 1477003366 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/4/2016 and was last updated on 9/23/2021.

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
1363LF0000XNurse PractitionerFamilyCNP-03049NEW MEXICOYes

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: 11/21/2025

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