Basic Information
| Provider Information | |||||||||
| NPI: | 1154379451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 T B STANLEY HWY | ||||||||
| Address2: | |||||||||
| City: | BASSETT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240556108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766291076 | ||||||||
| FaxNumber: | 2766292695 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 T B STANLEY HWY | ||||||||
| Address2: | |||||||||
| City: | BASSETT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240556108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766291076 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024166037 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.