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Individual
KELLY LYNNE CLARK
Active
Individual
KELLY LYNNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3377
KY
363A00000X
Physician Assistant
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100577880
—
KY
Enumeration date
08/27/2018
Last updated
02/13/2026
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