Clark, Sandra
Clark, Sandra is an sole proprietor health care provider with primary practice located at 139 County Road 379 , Water Valley MS 38965-3607. She recently has only one registered license in Technologists, Technicians & Other Technical Service Providers / Radiography, which is considered as her primary health care specialty. Clark, Sandra can be contacted via phone (662) 514-5215.Contact Information
Primary practice address
139 County Road 379
Water Valley MS 38965-3607
Phone: (662) 514-5215
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Technologists, Technicians & Other Technical Service Providers / Radiography | 2471C3402X | MRT2279 | Mississippi |
Profile Details
| NPI number | 1578692463 |
|---|---|
| LBN Legal business name | Clark, Sandra |
| Credentials | RT(R) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 5th, 2007 |
| Last updated | Jul 9th, 2007 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578692463 | NPPES |
| Mississippi | MEDICAID | 09851011 |
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