COTENNA D. CLARK NPI 1801401112

NPI Information

NPI: 1801401112
Provider Name: COTENNA D. CLARK
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
1857 CAMEO CT
TUCKER, GA
ZIP 30084
Phone: (678) 485-1156
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Cotenna D. Clark is a gerontology nurse practitioner in Tucker, GA with 5 years of experience. Cotenna D. Clark NPI is 1801401112. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: EMORY UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2019

The provider's business location address is:

1857 CAMEO CT
TUCKER, GA
ZIP 30084-002
Phone: (678) 485-1156

The NPI 1801401112 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 9/14/2020 and was last updated on 9/14/2020.

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	363LA2200X	Nurse Practitioner	Adult Health	RN231376	GEORGIA	No
2	363LG0600X	Nurse Practitioner	Gerontology	RN231376	GEORGIA	Yes

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: 4/28/2024

NPI Synchronization or Removal

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