Individual
MR. STEPHEN W. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1130 LOUISIANA AVE, SHREVEPORT, LA 71101-3908
(678) 227-1211
(318) 678-4185
Mailing address
4950 OAK POINT DR, SHREVEPORT, LA 71107-7409
(318) 227-1211
(318) 678-4185
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP01372
LA
Other
Enumeration date
12/12/2006
Last updated
07/08/2007
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