Provider Demographics
NPI:1548946171
Name:CLARK, APRIL M (CHERP- PRSS)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:CHERP- PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2822
Mailing Address - Country:US
Mailing Address - Phone:304-860-6458
Mailing Address - Fax:
Practice Address - Street 1:313 NEVILLE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4504
Practice Address - Country:US
Practice Address - Phone:304-254-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker