Individual
KRISTA M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
810 HADLEY AVE, OLD HICKORY, TN 37138-3121
(615) 847-8000
(615) 847-4693
Mailing address
810 HADLEY AVE, OLD HICKORY, TN 37138-3121
(615) 847-8000
(615) 847-4693
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454254
—
TN
01
—
4018836
BCBS OF TN
TN
Enumeration date
11/20/2006
Last updated
12/05/2007
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