Provider Information for 1205142106
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Mrs. SANDRA DENICE CLARK Ed.s
Sex: Female
NPI: 1205142106
Last Updated: 2010-08-31
Certification Date:
Certification Date:
Details
Name | Value | ||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
NPI | 1205142106 | ||||||||||||||||||||
Enumeration Date | 2010-08-30 | ||||||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||||||
Status | Active | ||||||||||||||||||||
Mailing Address | PO BOX 4128 MERIDIAN, MS 39304-4128 United States Phone: 601-581-7636 | Fax:601-581-7676 | ||||||||||||||||||||
Primary Practice Address | 5701 N HILLS ST MERIDIAN, MS 39307-2903 United States Phone: 601-581-7562 | Fax:601-581-7676 | ||||||||||||||||||||
Secondary Practice Address(es) | |||||||||||||||||||||
Health Information Exchange |
| ||||||||||||||||||||
Other Identifiers |
| ||||||||||||||||||||
Taxonomy |
|