Individual
MR. CLARK RAFAEL HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
THREE SHERIDAN SQUARE, KINGSPORT, TN 37660
(423) 392-6840
(423) 392-6845
Mailing address
THREE SHERIDAN SQUARE, KINGSPORT, TN 37660
(423) 392-6840
(423) 392-6845
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0000000871
TN
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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