Individual
TIMIERA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OWNER
Contact information
Practice address
5601 BRIDGE ST STE 300, FORT WORTH, TX 76112-2355
(817) 902-8085
Mailing address
5601 BRIDGE ST STE 300, FORT WORTH, TX 76112-2355
(817) 902-8085
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
019428
TX
Other
Enumeration date
08/08/2019
Last updated
08/08/2019
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