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Individual

KATRINA CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
25231 CUEVAS DELISLE RD, PASS CHRISTIAN, MS 39571-9386
(678) 516-5303
Mailing address
25231 CUEVAS DELISLE RD, PASS CHRISTIAN, MS 39571-9386
(678) 516-5303

Taxonomy

Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
RN210557
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0
N/A
Enumeration date
12/30/2020
Last updated
12/30/2020
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