Individual
KRIS D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1260 TEMPLE AVE, COLONIAL HEIGHTS, VA 23834-2984
(804) 518-2597
(804) 518-2598
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
(804) 217-7991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002643
VA
Other
Enumeration date
09/30/2005
Last updated
03/22/2021
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