Individual
KRISTINA M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
700 MCCLELLAN ST, SCHENECTADY, NY 12304-1019
(518) 372-5637
(518) 372-1384
Mailing address
711 TROY SCHENECTADY RD STE 203, LATHAM, NY 12110-2461
(518) 782-3700
(518) 782-3799
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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