Individual
ELIZABETH J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
275 COURT ST, IRVINE, KY 40336-1089
(606) 723-2167
(606) 723-2112
Mailing address
275 COURT ST, IRVINE, KY 40336-1089
(606) 723-2167
(606) 723-2112
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3006121
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1056565
RN LICENSE NUMBER
KY
01
—
3006121
ARNP LICENSE #
KY
05
—
7100085240
—
KY
Enumeration date
08/06/2009
Last updated
02/18/2022
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