Provider Demographics
NPI:1700161916
Name:CLARK & POWELL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CLARK & POWELL ASSOCIATES, LLC
Other - Org Name:DIABETES RESOURCE CENTER OF HOPKINSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:STEINMEYER
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MSRD, LD, CDE
Authorized Official - Phone:270-707-0060
Mailing Address - Street 1:530 NOEL AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1386
Mailing Address - Country:US
Mailing Address - Phone:270-707-0060
Mailing Address - Fax:270-707-0068
Practice Address - Street 1:530 NOEL AVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1386
Practice Address - Country:US
Practice Address - Phone:270-707-0060
Practice Address - Fax:270-707-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0517133V00000X
KY1765133VN1006X
KY1128308163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty