Individual
KELLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 W BARTLETTE ST, APT. 110, SUMTER, SC 29150-5173
(803) 236-6727
Mailing address
125 W BARTLETTE ST, APT. 110, SUMTER, SC 29150-5173
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PR31930
SC
Other
Enumeration date
12/20/2013
Last updated
12/20/2013
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