Individual
DR. KATHY L CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5261 CARROLLTON PIKE, SUITE B, WOODLAWN, VA 24381-3030
(276) 238-8876
(276) 238-8886
Mailing address
5261 CARROLLTON PIKE, SUITE B, WOODLAWN, VA 24381-3030
(276) 238-8876
(276) 238-8886
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101102706
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101102706
LC
VA
05
—
1972502938
—
VA
01
—
261083931
TAX ID
—
01
—
C10361
GROUP ORGANIZATION PTAN
—
01
—
DN2980
GROUP PTAN
—
Enumeration date
07/20/2005
Last updated
03/07/2023
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