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General NPI Number Information
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NPI Number | 1740756014
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE CLARK PREVENTION SPECIALIS
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Gender | Female
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 1212 BATH AVE FL 8
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City | ASHLAND
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State | KY
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Zip | 41101-2696
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Country | US
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Telephone | 606-329-8588
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 790
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City | ASHLAND
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State | KY
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Zip | 41105-0790
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Country | US
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Telephone | 606-329-8588
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Fax | 606-329-8195
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | NOTCERTIFIED
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License Number State | KY
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