Individual
NANCY S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 E CHESTNUT ST UNIT 710, LOUISVILLE, KY 40202
(502) 583-8303
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0325
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
50539
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413914300
—
MD
05
—
7100468230
—
KY
01
—
88260001
BLUE DC
DC
01
—
95QW
BLUE MD
MD
Enumeration date
03/20/2006
Last updated
01/25/2021
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