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Individual

BEVERLY W CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
78 HOSPITAL RD, MACON, MS 39341-2490
(662) 361-8338
Mailing address
4735 HIGHWAY 490 RD, MACON, MS 39341-9366
(662) 361-8338

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904987
MS

Other

Enumeration date
10/21/2021
Last updated
01/20/2022
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