Individual
MARY KIMBERLY CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0900036
NC
363LA2200X
Adult Health Nurse Practitioner
900035
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2592857A
MEDICARE PIN PTAN
NC
01
—
561380014G
HUMANA
—
01
—
811995
PARTNERS
NC
Enumeration date
03/23/2007
Last updated
05/01/2008
Update your record
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