Individual provider · Type 1 NPI
Gina Clark, APRN
Primary Care Nurse Practitioner · Louisville, KY
NPI number
1174912406
Active
Practice location
4200 Gardiner View Ave
Louisville, KY 40213-1877
Fax (502) 456-0496
Mailing address
3120 Runnymede Rd
Louisville, KY 40222-6144
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | 3008878 (KY) |
| Gerontology Nurse Practitioner | 363LG0600X | 3008878 (KY) |
| Primary Care Nurse Practitioner Primary | 363LP2300X | 3008878 (KY) |
Primary Care Nurse Practitioner: Definition to come...
3 other providers at this address
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About NPI 1174912406
Gina Clark, APRN's National Provider Identifier is 1174912406, issued on Jan 9, 2015. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Louisville, KY. The record was last updated on Aug 16, 2019.