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General NPI Number Information
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NPI Number | 1902689581
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Entity Type | Organization
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Legal Business Name | CLARK FAMILY MEDICAL PRACTICE, PLLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 3443 DICKERSON PIKE STE 660
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City | NASHVILLE
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State | TN
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Zip | 37207-2537
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Country | US
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Telephone | 615-988-1109
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Fax | 949-798-7514
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Provider Business Mailing Address
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Address Line | 3443 DICKERSON PIKE STE 660
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City | NASHVILLE
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State | TN
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Zip | 37207-2537
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Country | US
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Telephone | 615-988-1109
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Fax | 949-798-7514
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL CLARK
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Credential | FNP-C
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Telephone | 615-988-1109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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