Individual
HEATHER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN PMHNP-BC
Contact information
Practice address
506 N MAIN ST, NICHOLASVILLE, KY 40356-1134
(866) 934-7450
Mailing address
4600 MONTGOMERY RD STE 400, CINCINNATI, OH 45212-2600
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1137394
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4026229
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7101030890
—
KY
Enumeration date
09/03/2024
Last updated
12/12/2025
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