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General NPI Number Information
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NPI Number | 1700161916
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Entity Type | Organization
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Legal Business Name | CLARK & POWELL ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 530 NOEL AVE
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1386
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Country | US
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Telephone | 270-707-0060
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Fax | 270-707-0068
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Provider Business Mailing Address
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Address Line | 530 NOEL AVE
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1386
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Country | US
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Telephone | 270-707-0060
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Fax | 270-707-0068
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Authorized Official
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Title or Position | CEO
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Name | MRS. THERESA STEINMEYER CLARK
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Credential | M.S.R.D., L.D., CDE
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Telephone | 270-707-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 1765
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 1128308
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 0517
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License Number State | KY
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