IndividualActive
Theresa Clark
NPI 1104079839 · Medical-Surgical Registered Nurse · Pineville, LA
Provider details
- NPI number
- 1104079839
- Entity type
- Individual
- Primary specialty
- Medical-Surgical Registered NurseNursing Service Providers
- Sex
- Female
- Sole proprietor
- Yes
- License
- 163WM0705X (LA)
Specialties & taxonomies
Nursing Service Providers
Practice location
2495 Shreveport Hwy
Pineville, LA 71360-4044
Phone: (318) 473-0010
Approximate (ZIP-level) locationGet directions
Mailing address
107 Boundary Dr
Woodworth, LA 71485-9719
Registry dates
- Enumerated
- 2008-10-26
- Last updated
- 2008-10-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.