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Organization

CLARK FAMILY PRACTICE, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RUSSELL CLARK FNP-C (OWNER)
(615) 988-1109
Entity
Organization

Contact information

Practice address
3443 DICKERSON PIKE STE 660, NASHVILLE, TN 37207-2519
(615) 988-1109
(949) 798-7514
Mailing address
3443 DICKERSON PIKE STE 660, NASHVILLE, TN 37207-2519
(615) 988-1109
(949) 798-7514

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
20179
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Q034840
TN
Enumeration date
12/02/2017
Last updated
04/26/2018
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