Individual
KERESSA L. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 W STONE DR, SUITE 110, KINGSPORT, TN 37660-6027
(423) 224-3701
(423) 224-3709
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0024173732
VA
363LF0000X
Family Nurse Practitioner
Primary
21571
TN
Other
Enumeration date
07/20/2016
Last updated
09/14/2016
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