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Destiny Clark
Prosthetic/Orthotic Supplier in Ridgeland, Mississippi
NPI 1700578010

Destiny Clark is a Prosthetic/Orthotic Supplier based in Jackson, MS. Destiny Clark practices in Ridgeland, MS. The NPI Number for Destiny Clark is 1700578010 and holds a License No. (Mississippi).

The current practice location address for Destiny Clark is 6811 Old Canton Rd Apt 3305, Ridgeland, MS and can be reached out via phone at 769-231-7366. You can also correspond with Destiny Clark through the mailing address at 4780 I 55 N STE 100 PMB 2296, JACKSON, MS - 39211-5583 (mailing address contact number: 601-790-1738).

Location: 6811 Old Canton Rd Apt 3305, Ridgeland, MS, 39211-5583
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1700578010
Provider Name
Destiny Clark
Credential
Provider Entity Type
Individual
Gender
Female
Address
6811 Old Canton Rd Apt 3305, Ridgeland, MS, 39211-5583
Phone Number
769-231-7366
Fax Number
Provider Enumeration Date
05/24/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
6811 Old Canton Rd Apt 3305
City
Ridgeland
State
Mississippi
Zip
39157-1247
Phone Number
769-231-7366
Fax Number
person
Provider Business Mailing Address Details
Address
6811 Old Canton Rd Apt 3305
City
Ridgeland
State
Mississippi
Zip
39157-1247
Phone Number
769-231-7366
Fax Number
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
(Mississippi)
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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