| Doctor Name: | KRISTA M CLARK |
| NPI Number: | 1073687224 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 810 Hadley Ave Old Hickory, TN - 371383121 |
| Business Phone Number: | 6158478000 |
| Business Fax Number: | 6158474693 |
| Mailing Address: | 810 Hadley Ave, OLD HICKORY |
| State: | TN |
| Postal Code: | 371383121 |
| Phone Number: | 6158478000 |
| Fax Number: | 6158474693 |
| NPI Enumeration Date: | 11/20/2006 |
| NPI Last Update Date: | 12/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1744P3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | Prosthetics Case Management |
| Taxonomy Definition: | |