Provider Demographics
NPI:1245769850
Name:CLARK, KRISTEN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:ZIONCHECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15 HOSPITAL CENTER BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2760
Mailing Address - Country:US
Mailing Address - Phone:843-689-9200
Mailing Address - Fax:843-689-9200
Practice Address - Street 1:15 HOSPITAL CENTER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2760
Practice Address - Country:US
Practice Address - Phone:843-689-9200
Practice Address - Fax:843-689-9200
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMPA2748OtherSC LICENSE