| Clark Family Practice, Pllc | |
|
3443 Dickerson Pike Ste 660 Nashville TN 37207-2519 | |
| (615) 988-1109 | |
| (949) 798-7514 |
| Full Name | Clark Family Practice, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3443 Dickerson Pike Ste 660, Nashville, Tennessee |
| Authorized Official Name and Position | Russell Clark (OWNER) |
| Authorized Official Contact | 6159881109 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Family Practice, Pllc 3443 Dickerson Pike Ste 660 Nashville TN 37207-2519 Ph: (615) 988-1109 | Clark Family Practice, Pllc 3443 Dickerson Pike Ste 660 Nashville TN 37207-2519 Ph: (615) 988-1109 |
| NPI Number | 1396250155 |
|---|---|
| Provider Enumeration Date | 12/02/2017 |
| Last Update Date | 04/26/2018 |
| Medicare PECOS PAC ID | 8921369489 |
|---|---|
| Medicare Enrollment ID | O20180731001972 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396250155 | NPI | - | NPPES |
| Q034840 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 20179 (Tennessee) | Primary |
| Provider Name | Russell L Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548641087 PECOS PAC ID: 3870801525 Enrollment ID: I20150930001720 |
| Provider Name | Sarah Elizabeth Ryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356890982 PECOS PAC ID: 2365727633 Enrollment ID: I20170329000537 |
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