Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 30593 | TN |
NPI | 1013553494 |
---|---|
Provider Name | Eric Christopher Clark |
First Address | White House, TN 37188-2520 |
Second Address | Nashville, TN 37205-4900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2019 |
Last Update Date | 15/12/2021 |