Individual
KELLY ANNE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
7916 CARRAWAY CT, MAINEVILLE, OH 45039-8994
(513) 505-0588
Mailing address
7916 CARRAWAY CT, MAINEVILLE, OH 45039-8994
(513) 505-0588
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.0036958
OH
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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