Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 16181 | TN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 016181 | TN |
NPI | 1093726317 |
---|---|
Provider Name | Ms. Carol A Clark |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q024313 | (05) | TN |