Provider Demographics
NPI:1861366601
Name:CLARK, KIMBERLY ELAINE (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1909 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5642
Mailing Address - Country:US
Mailing Address - Phone:731-442-0687
Mailing Address - Fax:
Practice Address - Street 1:1909 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5642
Practice Address - Country:US
Practice Address - Phone:731-442-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF09250405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine