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Individual
ASHLEY LUCAS CLARK
Active
Individual
ASHLEY LUCAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21043
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210435
—
SC
01
—
57-1004971003
BCBS OF SC
SC
01
—
7742353
AETNA
SC
Enumeration date
06/23/2006
Last updated
05/17/2016
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