Individual
RICKY LYNN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
904 MUNICIPAL DR, BRANDON, MS 39042-2973
(601) 724-7310
Mailing address
103 PINE CV, CLINTON, MS 39056-5825
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0557
MS
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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