Individual
AMANDA M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
2301 TIMBERLINE CT APT F105, RUSTON, LA 71270
(210) 827-3950
Mailing address
2301 TIMBERLINE CT APT F105, RUSTON, LA 71270-5292
(210) 827-3950
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
321844
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255808085
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/30/2018
Last updated
03/20/2021
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