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NPI Code Detail

MEDICARE: KIMBERLY ELAINE CLARK FNP-C

MEDICARE: KIMBERLY ELAINE CLARK FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner40083TN

General Provider Information

NPI Number : 1861366601
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ELAINE CLARK FNP-C
Provider Business Mailing Address
First Line : 305 TYSON AVE
Second Line :
City : PARIS
State : TN
Zip : 38242-4579
Country : US
Telephone Number : 731-442-0687
Fax Number :
Provider Business Practice Location Address
First Line : 305 TYSON AVE
Second Line :
City : PARIS
State : TN
Zip : 38242-4579
Country : US
Telephone Number : 731-442-0687
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2025
Last Update Date : 12/08/2025

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Directions to “ KIMBERLY ELAINE CLARK FNP-C” Practice Location

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