Provider Demographics
NPI:1437589199
Name:CLARK, REBECCA SCOGGIN (NP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SCOGGIN
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 CHESTNUT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-7491
Mailing Address - Country:US
Mailing Address - Phone:828-434-0850
Mailing Address - Fax:
Practice Address - Street 1:413 MCCONNELL STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640
Practice Address - Country:US
Practice Address - Phone:336-246-9449
Practice Address - Fax:336-246-8163
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily