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Individual

KIMBERLY A CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
964701
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
554687
AZ
Enumeration date
09/16/2010
Last updated
11/05/2010
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