Individual
DR. KYLIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5050 NE HOYT ST, SUITE B55, PORTLAND, OR 97213-2991
(503) 233-5393
(503) 659-8984
Mailing address
5050 NE HOYT ST, SUITE B55, PORTLAND, OR 97213-2991
(503) 233-5393
(503) 659-8984
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD168562
OR
390200000X
Student in an Organized Health Care Education/Training Program
2011018538
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500674850
—
OR
Enumeration date
06/24/2011
Last updated
12/22/2014
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