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Individual

THRISHANNA CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Mailing address
815 CLOVER RIDGE WAY, BRANDON, MS 39047-4410
(601) 665-2953

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0024177537
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902942
MS

Other

Enumeration date
11/19/2018
Last updated
10/02/2025
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