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General NPI Number Information
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NPI Number | 1528689254
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Entity Type | Individual
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Provider Name | VINCENT DEVIN CLARK
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Gender | Male
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 1230 MARKET ST STE A
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City | LA GRANGE
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State | KY
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Zip | 40031-7986
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Country | US
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Telephone | 502-225-6900
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Fax | 502-666-7693
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Provider Business Mailing Address
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Address Line | 1230 MARKET ST STE A
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City | LA GRANGE
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State | KY
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Zip | 40031-7986
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Country | US
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Telephone | 502-225-6900
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Fax | 502-666-7693
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 61113
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License Number State | KY
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