Individual
TAMARA L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6050 VILLAGE DR, LINCOLN, NE 68516-4714
(402) 421-8581
(402) 421-8594
Mailing address
8055 O ST, STE 300, LINCOLN, NE 68510-2580
(402) 421-0896
(402) 421-0945
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1170
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245805
MIDLANDS CHOICE
—
01
—
37948
BCBS
NE
Enumeration date
08/02/2006
Last updated
04/07/2021
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