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KIMBERLY TENITA CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
202 E BAGLEY RD, BEREA, OH 44017-2058
(440) 260-8327
(440) 260-8305
Mailing address
3500 CARNEGIE AVE, CLEVELAND, OH 44115-2641
(440) 260-8900
(440) 260-8576

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
304700
OH
363L00000X
Nurse Practitioner
Primary
APRN.CNP.14022
OH
363L00000X
Nurse Practitioner
COA.14022
OH
363LA2200X
Adult Health Nurse Practitioner
A0812095
OH

Other

Enumeration date
10/17/2007
Last updated
10/03/2016
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