Provider Demographics
NPI:1043872864
Name:CLARK, KIMBERLEY AMBER (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:AMBER
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SCHENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-5353
Mailing Address - Country:US
Mailing Address - Phone:724-730-3212
Mailing Address - Fax:
Practice Address - Street 1:7629 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6082
Practice Address - Country:US
Practice Address - Phone:330-965-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024945363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner