Clark, Cristina M

Clark, Cristina M is an individual health care provider with primary practice located at 105 Skyline Dr , Russellville AR 72801-3363. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Clark, Cristina M can be contacted via phone (479) 968-2345.

Contact Information

Primary practice address
105 Skyline Dr Russellville AR 72801-3363
Fax: (479) 890-7125
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X E-7931 Arkansas

Profile Details

NPI number 1588807135
LBN Legal business name Clark, Cristina M
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2009
Last updated Feb 25th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588807135 NPPES
Arkansas MEDICAID 197270001

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