Individual
EDWARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN, LPN
Contact information
Practice address
6600 E BEN WHITE BLVD, AUSTIN, TX 78741-7537
(512) 804-3740
Mailing address
1430 COLLIER ST, AUSTIN, TX 78704-2911
(512) 472-4357
(512) 703-1394
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
200930549LPN
OR
164X00000X
Licensed Vocational Nurse
Primary
331536
TX
Other
Enumeration date
09/17/2017
Last updated
09/17/2017
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