Provider Demographics
NPI:1851141147
Name:CLARK, KANDY
Entity Type:Individual
Prefix:
First Name:KANDY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21766 WOODFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-9202
Mailing Address - Country:US
Mailing Address - Phone:440-212-8606
Mailing Address - Fax:
Practice Address - Street 1:21766 WOODFIELD TRL
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-9202
Practice Address - Country:US
Practice Address - Phone:440-212-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide