Individual
BRIAN KELLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
501 MEDICAL DR, HAMPTON, VA 23666-6080
(703) 295-9360
(703) 295-9369
Mailing address
PO BOX 37090, BALTIMORE, MD 21297-3090
(703) 295-9360
(703) 295-9369
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024165065
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010170699
—
VA
Enumeration date
03/31/2006
Last updated
03/08/2022
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