Individual
KATHLEEN A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1100 S MAIN ST, BLUFFTON, IN 46714-3615
(260) 919-3900
(260) 919-3913
Mailing address
1100 S MAIN ST, BLUFFTON, IN 46714-3615
(260) 919-3900
(260) 919-3913
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
74001171A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200334940
—
IN
Enumeration date
07/19/2006
Last updated
11/04/2015
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