Provider Demographics
NPI:1528554805
Name:CLUKEY, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CLUKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:SPOONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 CENTRAL MAINE XING
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-6320
Mailing Address - Country:US
Mailing Address - Phone:207-582-6608
Mailing Address - Fax:207-582-2258
Practice Address - Street 1:5 CENTRAL MAINE XING
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-6320
Practice Address - Country:US
Practice Address - Phone:207-582-6608
Practice Address - Fax:207-582-2258
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPAN1818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant