Individual
MRS. RICKETTA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
880 MADISON AVE, MEMPHIS, TN 38103-3409
(901) 490-7929
Mailing address
880 MADISON AVE, MEMPHIS, TN 38103-3409
(901) 490-7929
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7029
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3905917
—
TN
Enumeration date
08/23/2006
Last updated
11/09/2021
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