Provider Demographics
NPI:1710161831
Name:KRISTA M. CLARK
Entity Type:Organization
Organization Name:KRISTA M. CLARK
Other - Org Name:ESSENTIAL ACCENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:615-847-8000
Mailing Address - Street 1:810 HADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-3121
Mailing Address - Country:US
Mailing Address - Phone:615-847-8000
Mailing Address - Fax:615-847-4693
Practice Address - Street 1:810 HADLEY AVE
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-3121
Practice Address - Country:US
Practice Address - Phone:615-847-8000
Practice Address - Fax:615-847-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454254Medicaid
TN4018836OtherBCBS OF TN
TN4018836OtherBCBS OF TN