Individual
HALEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 JAY ST, STANFORD, KY 40484-7511
(606) 365-5746
Mailing address
436 LOGAN CREEK DR, STANFORD, KY 40484-9524
(859) 324-5746
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC419
KY
Other
Enumeration date
09/23/2015
Last updated
06/25/2019
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