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General NPI Number Information
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NPI Number | 1912612961
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Entity Type | Organization
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Legal Business Name | CLARK FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 01/13/2023
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 293 W MAIN ST
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City | BYESVILLE
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State | OH
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Zip | 43723-1137
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Country | US
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Telephone | 740-685-6800
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Fax | 833-681-2626
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Provider Business Mailing Address
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Address Line | 293 W MAIN ST
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City | BYESVILLE
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State | OH
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Zip | 43723-1137
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Country | US
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Telephone | 740-685-6800
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Fax | 833-681-2626
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Authorized Official
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Title or Position | APRN/OWNER
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Name | ELISHA ANNE CLARK
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Credential | APRN
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Telephone | 740-685-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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