Individual
JEFFREY SCOTT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-6111
Mailing address
1009 LARK ST STE 2, JOHNSON CITY, TN 37604-8218
(423) 283-0776
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024185771
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
14744
TN
Other
Enumeration date
05/15/2007
Last updated
12/15/2023
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