Individual
DOMINIQUE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1540 APPLING CARE LN, CORDOVA, TN 38016-4957
(901) 444-3950
Mailing address
1540 APPLING CARE LN STE 105, CORDOVA, TN 38016-4947
(901) 444-3970
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
174756
TN
363LF0000X
Family Nurse Practitioner
Primary
27344
TN
Other
Enumeration date
02/25/2020
Last updated
11/13/2020
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