Individual
CASSIDY RAE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
MEDICAL CENTER BOULEVARD 7TH FLOOR, WINSTON SALEM, NC 27157-7768
(336) 716-3182
Mailing address
MEDICAL CENTER BOULEVARD 7TH FLOOR, WINSTON SALEM, NC 27157-7768
(336) 716-3182
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-11035
NC
Other
Enumeration date
02/09/2021
Last updated
08/06/2021
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