Provider Demographics
NPI:1548497084
Name:CLARK, ASHLEY (APRN, NP-C, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN, NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DANIELLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C, PMHNP-BC
Mailing Address - Street 1:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-1726
Mailing Address - Country:US
Mailing Address - Phone:225-255-0899
Mailing Address - Fax:225-341-4345
Practice Address - Street 1:2900 WESTFORK DR STE 401
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827-0004
Practice Address - Country:US
Practice Address - Phone:225-255-0899
Practice Address - Fax:225-341-4345
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA122036163W00000X
LAAP06868363LF0000X, 363LP2300X, 363LP0808X
COC-APN.0100900-C-NP363LP0808X
MDAC005595363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2308360Medicaid
LA330027YXK5Medicare Oscar/Certification