Individual
KELLYANN T CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-3359
(703) 776-2338
Mailing address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-3359
(703) 776-2338
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024170317
VA
Other
Enumeration date
10/09/2012
Last updated
01/27/2022
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