Theresa S Clarke, PA
Individual provider Active NPI Medical Physician Assistant · Angier, NC
NPI 1447446174 · NPPES record last updated Dec 15, 2010
Key facts
- NPI
- 1447446174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 103209 (NC)
- Practice address
- 800 N Raleigh Street C1
Angier, NC 27501-7547 - Phone
- (919) 331-0031
- Fax
- (919) 338-2627
- NPI assigned
- Sep 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103209 | NC | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Good Samaratan Family Practice & Urgent Care, PLLC | Medical | Past | Accepting new patients |
| Independence Medical, PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 103209 | NC | Yes |
Addresses
Primary practice location
800 N Raleigh Street C1
Angier, NC 27501-7547
Mailing address
800 N Raleigh St Ste C1
Angier, NC 27501-8613
Phone (919) 331-0031
Other providers in Angier, NC
- David Carter
- Marianna Chambers
- Vivian Ann Chance
- Calista Ijeoma Chukwu
- Lenique Clark
- Aaron Cockburn
- Compassionate Adult Care
- Sarah Cash Corpening
- Georyos Dahdal
- Ana Daley
All providers in Angier, NC · Medical Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.