Provider Demographics
NPI:1851739874
Name:CLARK, GENEVA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WHISPERING RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-4639
Mailing Address - Country:US
Mailing Address - Phone:901-466-1912
Mailing Address - Fax:
Practice Address - Street 1:3041 GETWELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3737
Practice Address - Country:US
Practice Address - Phone:901-375-1050
Practice Address - Fax:901-375-1588
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse