Individual
GRAYCEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-BC
Contact information
Practice address
130 RAVINE RD, KINGSPORT, TN 37660-3831
(423) 224-4000
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
(423) 282-1657
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
38211
TN
Other
Enumeration date
02/15/2025
Last updated
11/14/2025
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