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Organization
KATHLEEN A. CLARK MD PA
Active
Organization
KATHLEEN A. CLARK MD PA
Active
Other names
Southwest Anti-Aging Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN ANNE CLARK (MD)
(806) 350-7311
Entity
Organization
Contact information
Practice address
5701 TIME SQUARE BLVD STE 220, AMARILLO, TX 79119-1178
(806) 350-7311
(806) 350-7361
Mailing address
5701 TIME SQUARE BLVD STE 220, AMARILLO, TX 79119-1178
(806) 350-7311
(806) 350-7361
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
P8871
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083085385
NPI
TX
Enumeration date
10/13/2015
Last updated
11/09/2017
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