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Ricky Clark
NPI 1639608136 · on the registry since 2017 · sole proprietor
Practice
- Address
- 904 Municipal Dr
Brandon, MS 39042 - Phone
- (601) 724-7310
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 2255A2300X
2255A2300X
- Licence states on file
- MS
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2017-06-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Mississippi