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Individual

DR. CASEY LANE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1850 BYPASS RD, WINCHESTER, KY 40391-2300
(859) 744-5111
(859) 744-1177
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(859) 744-5111
(859) 744-1177

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
56386
KY
208000000X
Pediatrics Physician
56386
KY
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100615740
KY
Enumeration date
03/23/2018
Last updated
05/11/2022
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