NPI 1700578010

Destiny Clark

Practitioner Prosthetic/Orthotic Supplier Ridgeland, MS

Practice location

Address: 6811 Old Canton Rd APT 3305, Ridgeland, MS 39157-1247
Phone: (769) 231-7366
Mailing address: 4780 I 55 N STE 100 Pmb 2296, Jackson, MS 39211-5583

Registered specialties

Prosthetic/Orthotic Supplier Primary

Suppliers Taxonomy 335E00000X

Other Prosthetic/Orthotic Supplier providers in Mississippi →

Registry record

NPI: 1700578010
Entity type: Individual
Sex (as registered): Female
NPI issued: 24 May 2023
Record last updated: 24 May 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.