Mrs Carol Laceshia Clark, LPN is a
Licensed Practical Nurse based in Jackson, South Carolina. Mrs Carol Laceshia Clark is licensed to practice in South Carolina (license number 46401) and her current practice location is
139 Pauline St, Jackson, South Carolina. She can be reached at her office (for appointments etc.) via phone at
(803) 450-6770.
NPI number for Mrs Carol Laceshia Clark is 1487432449 and her current mailing address is 139 Pauline St, Jackson, South Carolina. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1487432449.
Provider's Profile
| Full Name | Mrs Carol Laceshia Clark |
|---|
| Gender | Female |
|---|
| Speciality | Licensed Practical Nurse |
|---|
| Location | 139 Pauline St, Jackson, South Carolina |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1487432449
- Provider Enumeration Date: 09/20/2023
- Last Update Date: 09/20/2023
Medical Identifiers
Medical identifiers for Mrs Carol Laceshia Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1487432449 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 164W00000X | Licensed Practical Nurse | 46401 (South Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Carol Laceshia Clark is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mrs Carol Laceshia Clark, LPN
139 Pauline St,
Jackson, SC 29831-3136
Ph: (803) 450-6770 | Mrs Carol Laceshia Clark, LPN
139 Pauline St,
Jackson, SC 29831-3136
Ph: (803) 450-6770 |
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