Individual
GINA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4200 GARDINER VIEW AVE, LOUISVILLE, KY 40213-1877
(502) 456-0494
(502) 456-0496
Mailing address
3120 RUNNYMEDE RD, LOUISVILLE, KY 40222-6144
(502) 657-1076
(888) 959-2460
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3008878
KY
363LG0600X
Gerontology Nurse Practitioner
3008878
KY
363LP2300X
Primary Care Nurse Practitioner
Primary
3008878
KY
Other
Enumeration date
01/09/2015
Last updated
08/16/2019
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