Provider Demographics
NPI:1831501501
Name:LARK MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:LARK MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOUSEWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-393-4052
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BULLS GAP
Mailing Address - State:TN
Mailing Address - Zip Code:37711-0008
Mailing Address - Country:US
Mailing Address - Phone:423-393-4052
Mailing Address - Fax:423-933-2915
Practice Address - Street 1:275 HIGHWAY 11 E
Practice Address - Street 2:
Practice Address - City:BULLS GAP
Practice Address - State:TN
Practice Address - Zip Code:37711-3417
Practice Address - Country:US
Practice Address - Phone:423-393-4052
Practice Address - Fax:423-933-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
TNAPN0000006848363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009488Medicaid