Individual
JONATHAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1720 NICHOLASVILLE RD STE 601, LEXINGTON, KY 40503-1451
(859) 260-4331
Mailing address
417 DABNEY DR, LEXINGTON, KY 40509-1870
(859) 421-6638
Taxonomy
Speciality
Code
Description
License number
State
2084A2900X
Neurocritical Care Physician
Primary
TC055
KY
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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