Individual
KAYLA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 VIRGINIA ST E STE 400, CHARLESTON, WV 25301-2835
(681) 313-4759
Mailing address
900 VIRGINIA ST E STE 400, CHARLESTON, WV 25301-2835
(681) 313-4759
(844) 800-3954
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
39817
WV
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487758710
—
WV
Enumeration date
12/23/2020
Last updated
11/17/2022
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