Individual
TODD V CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
249 E BRANNON RD, NICHOLASVILLE, KY 40356-8059
(859) 354-5455
(859) 203-8833
Mailing address
249 E BRANNON RD, NICHOLASVILLE, KY 40356-8059
(859) 354-5455
(859) 203-8833
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
42806
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000612211
ANTHEM BLUE CROSS & BLUE SHIELD
—
Enumeration date
04/01/2009
Last updated
07/10/2025
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