Individual
MISS LATOYA M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8600
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8600
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
967127
NY
Other
Enumeration date
10/19/2011
Last updated
05/13/2014
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