Provider Demographics
NPI:1720863665
Name:CLARK, SARABETH LEE (NP)
Entity type:Individual
Prefix:
First Name:SARABETH
Middle Name:LEE
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:877-348-1281
Mailing Address - Fax:901-227-3206
Practice Address - Street 1:2173 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6309
Practice Address - Country:US
Practice Address - Phone:601-605-3858
Practice Address - Fax:601-605-3898
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2024-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS865829363LF0000X
MS906228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily