KELLY CLARK

IRMO, SC
NPI1639840580
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: SC  25865)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2021-09-21
Last Update Date2022-03-07
Business Address
KELLY CLARK
11134 BROAD RIVER RD STE D
IRMO, SC 29063-7616
Phone number: 803-732-0920
Mailing Address
KELLY CLARK
11134 BROAD RIVER RD STE D
IRMO, SC 29063-7616
Phone number: