Individual
KEELY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNFA
Contact information
Practice address
1500 COOPER ST, FORT WORTH, TX 76104-2710
(682) 885-6400
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-1860
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
729115
TX
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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