Individual
MCKENZIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
51 NASSAU ST, CHARLESTON, SC 29403-5513
(843) 722-4112
Mailing address
157 QUEEN ST APT A, CHARLESTON, SC 29401-2056
(941) 726-2825
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
22661
SC
Other
Enumeration date
01/31/2018
Last updated
09/05/2019
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