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Individual

MARY KIMBERLY CLARKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
500 CAROLINA MEADOWS, CHAPEL HILL, NC 27517-8471
(919) 370-7102
(919) 942-0377
Mailing address
100 CAROLINA MEADOWS, CHAPEL HILL, NC 27517-8510
(919) 942-4014
(919) 942-0377

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
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