Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 234589 | NC |
NPI | 1043678170 |
---|---|
Provider Name | Katherine Clark |
First Address | Whitsett, NC 27377-9322 |
Second Address | Whitsett, NC 27377-9296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 24/09/2021 |