Healthcare Provider Details

I. General information

NPI: 1285580050
Provider Name (Legal Business Name): KATHRYN CLARK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE STE 301
CARMICHAEL CA
95608-0303
US

IV. Provider business mailing address

6555 COYLE AVE STE 301
CARMICHAEL CA
95608-0303
US

V. Phone/Fax

Practice location:
  • Phone: 916-962-1544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95421706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: