Individual
MS. KERRY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, AGNP-BC
Contact information
Practice address
4660 KENMORE AVE STE 305&500, ALEXANDRIA, VA 22304-1313
(703) 751-5763
(703) 370-8704
Mailing address
224D CORNWALL ST NW STE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
RN1038780
DC
363LA2200X
Adult Health Nurse Practitioner
0024178999
VA
363LG0600X
Gerontology Nurse Practitioner
Primary
0024178999
VA
363LP2300X
Primary Care Nurse Practitioner
0024178999
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932575743
—
VA
05
—
30016021870002
—
VA
Enumeration date
08/15/2015
Last updated
02/17/2026
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