Individual
NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HAIR LOSS SPECIALIST
Contact information
Practice address
100 N BURKE AVE, LONG BEACH, MS 39560-4605
(228) 234-1658
Mailing address
100 N BURKE AVE, LONG BEACH, MS 39560-4605
(228) 234-1658
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
04/01/2019
Last updated
04/01/2019
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