Provider Demographics
NPI:1689251811
Name:CLARK, KARA (ARNP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:PEZANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10316 NE 187TH ST APT 405
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3888
Mailing Address - Country:US
Mailing Address - Phone:206-407-5889
Mailing Address - Fax:
Practice Address - Street 1:10316 NE 187TH ST APT 405
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3888
Practice Address - Country:US
Practice Address - Phone:206-407-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61111745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily