Provider Demographics
NPI:1821284787
Name:CLARK, KENDRA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KENDRA
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:9312 E RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2094
Mailing Address - Country:US
Mailing Address - Phone:480-374-4339
Mailing Address - Fax:
Practice Address - Street 1:9312 E RAINTREE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2094
Practice Address - Country:US
Practice Address - Phone:480-374-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant