Individual
DIANA KATHERINE CLARK-MCGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1450 KINGWOOD DR, KINGWOOD, TX 77339-3040
(832) 548-4420
Mailing address
1450 KINGWOOD DR, KINGWOOD, TX 77339-3040
(832) 548-4420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00395
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89N545
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/13/2005
Last updated
06/19/2020
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