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LISA S CLARK
>> Case Manager/Care Coordinator >> Other Service ProvidersRegistrant NPI Number: 1902114762
Individual Registrant: LISA S CLARK
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
931 HIGHWAY 5 ROSE BUD, AR 72137-9721 US
Tel: 866-533-1766 Fax: --
Tel: 866-533-1766 Fax: --
Contact information for business:
5725 HIGHWAY 36 W ROSE BUD, AR 72137-9705 US
Tel: 866-533-1766 Fax: --
Tel: 866-533-1766 Fax: --
Registration Information:
NPI: 1902114762
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 171M00000X | Other Service Providers Case Manager/Care Coordinator |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
