Individual
KELLY S CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
15716 W HIGH ST # 597, MIDDLEFIELD, OH 44062-9201
(440) 632-8071
Mailing address
15716 W HIGH ST, P O BOX 597, MIDDLEFIELD, OH 44062-9201
(440) 632-8071
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
131431
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
APPLYING FOR NUMBER NOW.
—
Enumeration date
10/14/2010
Last updated
10/14/2010
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