Individual
JOANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1314 LAKE ST, FT WORTH, TX 76102-4581
(817) 810-0660
Mailing address
3901 LINKMEADOW DR, ALEDO, TX 76008-3568
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
714003
TX
Other
Enumeration date
02/21/2018
Last updated
02/21/2018
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