MRS. SHANTERA CLARK FNP-C NPI 1962020057

NPI Information

NPI: 1962020057
Provider Name: MRS. SHANTERA CLARK, FNP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
630 OGEECHEE DR W
STATESBORO, GA
ZIP 30461
Phone: (478) 456-0238
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MRS. Shantera Clark, FNP-C is a family nurse practitioner in Statesboro, GA with 5 years of experience. MRS. Shantera Clark, FNP-C NPI is 1962020057. 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:

630 OGEECHEE DR W
STATESBORO, GA
ZIP 30461-753
Phone: (478) 456-0238

The NPI 1962020057 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 7/6/2020 and was last updated on 8/4/2022.

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	RN220889	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: 5/5/2024

NPI Synchronization or Removal

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