Individual
ELIZABETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 E CHESTNUT ST STE 303, LOUISVILLE, KY 40202-1831
(502) 629-5552
Mailing address
1536 ANNA LN, LOUISVILLE, KY 40216-5469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC034
KY
Other
Enumeration date
08/30/2024
Last updated
09/11/2024
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