Provider Demographics
NPI:1710147145
Name:CLARK, KARA ANNE (ACNP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11601 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1466
Mailing Address - Country:US
Mailing Address - Phone:804-285-6880
Mailing Address - Fax:804-706-1585
Practice Address - Street 1:11601 IRON BRIDGE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1466
Practice Address - Country:US
Practice Address - Phone:804-285-6880
Practice Address - Fax:804-706-1585
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167520363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN
VA1710147145OtherNPI