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Individual

KATHRYN M CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-6186
Mailing address
PO BOX 15609, DURHAM, NC 27704-0609
(919) 384-0700
(919) 384-0600

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 128359
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
1689
NC
367500000X
Certified Registered Nurse Anesthetist
AANA 077459
NC

Other

Enumeration date
07/26/2007
Last updated
08/09/2021
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