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NPI Profile for JEANETTA CLARK in TULLAHOMA, TN.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
School |
101YS0200X |
| NPI Number | 1003298639 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 06/19/2015 | |
| Last updated | 06/19/2015 - About 11 years ago | |
| Sole proprietor 1 | No | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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JEANETTA CLARK
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JEANETTA CLARK