Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | P4038 | TX |
Y | 213ES0000X | Sports Medicine | P4038 | TX |
NPI | 1093977449 |
---|---|
Provider Name | Dr. Khalilah Q Clarke |
First Address | Fort Worth, TX 76107-2569 |
Second Address | Fort Worth, TX 76107-2569 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 10/02/2020 |