Clark, Amanda M

Clark, Amanda M is an individual health care provider with primary practice located at 2301 Timberline Ct Apt F105 , Ruston LA 71270. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as her primary health care specialty. Clark, Amanda M can be contacted via phone (210) 827-3950.

Contact Information

Primary practice address
2301 Timberline Ct Apt F105 Ruston LA 71270
Phone: (210) 827-3950
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 321844 Louisiana

Profile Details

NPI number 1255808085
LBN Legal business name Clark, Amanda M
Credentials ATC, LAT
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 30th, 2018
Last updated Mar 20th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255808085 NPPES
Texas Other 1255808085 BLUE CROSS BLUE SHIELD

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