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:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1050 RIVER OAKS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9564
Mailing Address - Country:US
Mailing Address - Phone:601-420-0134
Mailing Address - Fax:601-709-2452
Practice Address - Street 1:1050 RIVER OAKS DR STE 200
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9564
Practice Address - Country:US
Practice Address - Phone:601-420-0134
Practice Address - Fax:601-709-2452
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS363LF0000X207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology