Individual
S KATHLEEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1132 DOW ST, MURFREESBORO, TN 37130-2486
(615) 896-2617
Mailing address
135 CHERRY LN, MURFREESBORO, TN 37130-3935
(615) 896-2617
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD0000015766
TN
207NS0135X
Procedural Dermatology Physician
MD0000015766
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018534
TENNESSEE BLUE CROSS BLUE
TN
01
—
110025193
RAILROAD MEDICARE
TN
05
—
3032646
—
TN
Enumeration date
10/26/2006
Last updated
01/22/2019
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