Individual
B. CAROL CLARK-KUTSCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 457-3065
(618) 457-0469
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209007469
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428317200
—
MO
Enumeration date
09/13/2006
Last updated
11/25/2024
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