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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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