Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ricky Lynn Clark

Individual provider Athletic Trainer · NPI 1639608136

Ricky Lynn Clark is an Athletic Trainer in Brandon, Mississippi. Practices as a sole proprietor. Licensed in Mississippi.

Licensed in
MS
In the registry since
2017
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Practice location Address checks out

904 Municipal Dr
Brandon, MS 39042-2973
Phone: (601) 724-7310
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence AT0557 (MS)

Record details

NPI number1639608136
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 8, 2017
Last updated in NPPESJune 8, 2017
Mailing address103 Pine Cv, Clinton, MS 39056-5825

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