Provider Demographics
NPI:1033716717
Name:CLARK, KARA (NP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:DRUMMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7894
Mailing Address - Country:US
Mailing Address - Phone:207-621-7550
Mailing Address - Fax:207-621-7573
Practice Address - Street 1:15 GRACELAWN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6334
Practice Address - Country:US
Practice Address - Phone:207-753-3080
Practice Address - Fax:207-753-3088
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner