Individual
KRISTINA M CLARK
Active
Individual
KRISTINA M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
501366
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
382310
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03494502
—
NY
01
—
120919000071
FIDELIS CARE NY
NY
Enumeration date
06/25/2012
Last updated
01/25/2018
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