Individual
KRISTEN M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4201
(401) 444-5527
Mailing address
593 EDDY ST, HASBRO 122, PROVIDENCE, RI 02903-4923
(401) 444-4201
(401) 444-5527
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
NPP37652
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NPP37652
LICENSE
RI
Enumeration date
11/22/2011
Last updated
11/22/2011
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