Melanie Jo Clark, MSN, APRN
Nurse Practitioner, Family in Louisville, KY. Individual provider (NPI-1).
NPI number1114201795
StatusActive
Last updated in NPPESJan 12, 2021
Details
- NPI
- 1114201795
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Melanie Jo Clark
- Credential
- MSN, APRN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 30, 2011
- Certification date
- Jan 12, 2021
- Last updated
- Jan 12, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 3006627 | KY | Yes |
| 363LW0102X | Nurse Practitioner, Women's Health | 3006627 | KY |
Practice location
7926 Preston HighwaySuite 106
Louisville, KY 40219-3848
Phone 502-964-4357 · Fax 502-966-5948
Mailing address
Po Box 776351Chicago, IL 60677-6351
Phone 502-588-9490 · Fax 502-272-5116
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