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General NPI Number Information
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NPI Number | 1043650591
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Entity Type | Organization
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Legal Business Name | CLARK MEDICAL VENTURES, LLC
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 174 PEDRO WAY
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City | WINCHESTER
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State | KY
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Zip | 40391-8354
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Country | US
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Telephone | 859-355-5653
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 WELLINGTON WAY STE 240
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City | LEXINGTON
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State | KY
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Zip | 40513-1257
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Country | US
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Telephone | 859-303-8746
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | BRITTANY UNDERWOOD
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Credential |
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Telephone | 859-303-8746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | KY
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #7
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #9
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #10
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #11
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #12
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 900176
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License Number State | KY
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