Individual
TAMMY DAWN CLARK-MOATS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21 E MAIN ST STE 302, BUCKHANNON, WV 26201-2910
(304) 473-6802
Mailing address
24 LIGHT HOLLOW RD, HACKER VALLEY, WV 26222-8402
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95523
WV
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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