Individual
KYLIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 SPRING GARDEN ST STE R105, PHILADELPHIA, PA 19130-4067
(484) 844-2388
Mailing address
1500 SPRING GARDEN ST STE R105, PHILADELPHIA, PA 19130-4067
(484) 844-2388
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA065010
PA
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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