Organization
CLARK MEDICAL VENTURES, LLC
Active
Organization
CLARK MEDICAL VENTURES, LLC
Active
Other names
Clark Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANY UNDERWOOD (CREDENTIALING AGENT)
(859) 303-8746
Entity
Organization
Contact information
Practice address
174 PEDRO WAY, WINCHESTER, KY 40391-8354
(859) 355-5653
Mailing address
1031 WELLINGTON WAY STE 240, LEXINGTON, KY 40513-1257
(859) 303-8746
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
KY
1041C0700X
Clinical Social Worker
—
KY
207P00000X
Emergency Medicine Physician
—
KY
207Q00000X
Family Medicine Physician
—
KY
207R00000X
Internal Medicine Physician
—
KY
261QR1300X
Rural Health Clinic/Center
Primary
900176
KY
363L00000X
Nurse Practitioner
—
KY
363LA2100X
Acute Care Nurse Practitioner
—
KY
363LF0000X
Family Nurse Practitioner
—
KY
363LP0200X
Pediatric Nurse Practitioner
—
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
KY
363LW0102X
Women's Health Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100303720
—
KY
Enumeration date
06/28/2013
Last updated
09/02/2021
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