| NPI | 1295199941 |
|---|---|
| Former Name | STACY N CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010213) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71007669A) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2022-02-01 |