IndividualActive
Destiny Clark
NPI 1700578010 · Prosthetic/Orthotic Supplier · Ridgeland, MS
Provider details
- NPI number
- 1700578010
- Entity type
- Individual
- Primary specialty
- Prosthetic/Orthotic SupplierSuppliers
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Suppliers
Practice location
6811 Old Canton Rd Apt 3305
Ridgeland, MS 39157-1247
Phone: (769) 231-7366
Approximate (ZIP-level) locationGet directions
Mailing address
4780 I 55 N Ste 100 Pmb 2296
Jackson, MS 39211-5583
Registry dates
- Enumerated
- 2023-05-24
- Last updated
- 2023-05-24
- Certified
- 2023-05-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.