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Individual
KATHLEEN ANNE CLARK
Active
Individual
KATHLEEN ANNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
251181-1
NY
207R00000X
Internal Medicine Physician
Primary
42540
TX
207V00000X
Obstetrics & Gynecology Physician
42540
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199457601
—
TX
01
—
199457602
MEDICAID - OB/GYN
TX
05
—
200232280 A
—
OK
05
—
83982876
—
NM
01
—
8L20138
MEDICARE - OB/GYN
TX
01
—
8L8001
MEDICARE
TX
Enumeration date
12/16/2008
Last updated
03/28/2018
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