Individual
MR. KELLY O'BRIAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N., M.S.N., F.N.P.
Contact information
Practice address
1002 S EDGEWOOD DR, KNOX, IN 46534-8226
(574) 772-6030
(574) 772-7494
Mailing address
1002 S EDGEWOOD DR, KNOX, IN 46534-8226
(574) 772-6030
(574) 772-7494
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71000435A
IN
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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