Individual
KRISTY NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
129 N PURITAN STREET, SHINGLEHOUSE, PA 16748
(814) 260-9352
Mailing address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(814) 274-9300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP020957
PA
Other
Enumeration date
10/12/2019
Last updated
10/11/2021
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