Clark, Debra

Clark, Debra is an individual health care provider with primary practice located at 250 Charlois Blvd , Winston Salem NC 27103-1508. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Clark, Debra can be contacted via phone (336) 718-1000.

Contact Information

Primary practice address

250 Charlois Blvd Winston Salem NC 27103-1508

Phone: (336) 718-1000

Fax: (336) 718-1052

Website:

Map and Directions

Health care specialties

Specialty	Code	License #	State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant	363A00000X	103316	North Carolina

Profile Details

NPI number	1720058282
LBN Legal business name	Clark, Debra
Credentials	Physician's Assistant Certified (PA-C)
Entity	Individual
Sole proprietor ¹	No
Enumeration date	Jan 25th, 2006
Last updated	Apr 8th, 2016 - about 10 years ago

¹ A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

State	Type	Number	Issuer
All States	NPI	1720058282	NPPES
North Carolina	MEDICAID	8101696

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