Individual
MELISSA DARLENE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
105 WAVERLY PLZ, WAVERLY, TN 37185-1531
(931) 296-4356
(931) 296-4529
Mailing address
2195 DARRELL RYE RD, ERIN, TN 37061-6933
(931) 289-5254
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0000068909
TN
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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