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General NPI Number Information
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NPI Number | 1669861944
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Entity Type | Organization
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Legal Business Name | KOURTNEY CLARK PLLC
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 5420 DASHWOOD DR STE 310
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City | HOUSTON
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State | TX
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Zip | 77081-5360
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Country | US
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Telephone | 713-512-1267
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Fax | 713-512-1199
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Provider Business Mailing Address
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Address Line | 5420 DASHWOOD DR STE 310
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City | HOUSTON
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State | TX
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Zip | 77081-5360
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Country | US
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Telephone | 713-512-1267
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Fax | 713-512-1199
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KOURTNEY CLARK
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Credential |
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Telephone | 713-512-1267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 80468
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License Number State | TX
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