Individual
DEBORAH S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
210 N MAIN ST, MORGANTOWN, KY 42261-7919
(270) 526-3137
(270) 526-4829
Mailing address
PO BOX 148, HARTFORD, KY 42347-0148
(270) 504-1300
(270) 504-1380
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3005972
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000620424
ANTHEM # WITH CHS, INC.
KY
05
—
200975180
—
IN
05
—
7100082850
—
KY
Enumeration date
03/13/2009
Last updated
05/22/2015
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