Individual
KRISTEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
537 UNION AVE, GRANTS PASS, OR 97527-5543
(541) 761-0048
Mailing address
PO BOX 726, MERLIN, OR 97532-0726
(541) 761-0048
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1025091
OR
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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