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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578692463 NPPES
Mississippi MEDICAID 09851011

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