Individual
JESSICA AUTUMN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
860 S MADISON ST, TUPELO, MS 38801-4905
(615) 513-4978
Mailing address
104 WESTFIELD CT, SMYRNA, TN 37167-5249
(615) 513-4978
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MS
Other
Enumeration date
04/24/2022
Last updated
04/24/2022
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