Individual
MRS. KATHLEEN MARY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
2800 ASHLAND RD, COLUMBIA, SC 29210-5010
(803) 476-8509
(803) 476-8520
Mailing address
2800 ASHLAND RD, COLUMBIA, SC 29210-5010
(803) 476-8509
(803) 476-8520
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
42521
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42521
—
SC
Enumeration date
04/23/2013
Last updated
04/23/2013
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