Individual
MRS. KRISTIN MARIE JEROME CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14010 SMOKETOWN RD STE 117, WOODBRIDGE, VA 22192-4704
(718) 920-6656
Mailing address
14010 SMOKETOWN RD, WOODBRIDGE, VA 22192-4722
(201) 669-8040
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003441
VA
Other
Enumeration date
09/01/2009
Last updated
04/06/2016
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