Individual
MRS. CRYSTAL L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CRNA
Contact information
Practice address
800 ROSE ST, N202, LEXINGTON, KY 40536-0001
(859) 323-5956
Mailing address
800 ROSE ST, N202, LEXINGTON, KY 40536-0001
(859) 323-5956
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.347094-COA1
OH
367500000X
Certified Registered Nurse Anesthetist
103183
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
1108974
KY
367500000X
Certified Registered Nurse Anesthetist
COA.14396-NA
OH
Other
Enumeration date
02/07/2012
Last updated
06/06/2016
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