Individual
ALICIA H CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
518 WEST GUM STREET, MARION, KY 42064-1516
(270) 965-5238
(270) 965-9015
Mailing address
PO BOX 559, MARION, KY 42064-0559
(270) 965-5238
(270) 965-9015
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3004261
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324690
ANTHEM BCBS
—
05
—
78011640
—
KY
01
—
P00140734
RAILROAD MEDICARE
—
Enumeration date
08/12/2005
Last updated
02/09/2011
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