Individual
KELLY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 726-2000
Mailing address
33 ANDERSON ST APT 2, BOSTON, MA 02114-3621
(857) 445-1462
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN167845
MA
Other
Enumeration date
03/07/2014
Last updated
03/07/2014
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