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General NPI Number Information
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NPI Number | 1003478157
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Entity Type | Organization
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Legal Business Name | K.Q. CLARKE, MD, PLLC
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1307 8TH AVE STE 603
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City | FORT WORTH
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State | TX
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Zip | 76104-4142
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Country | US
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Telephone | 817-662-7044
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Fax | 817-438-1969
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Provider Business Mailing Address
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Address Line | 1307 8TH AVE STE 603
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City | FORT WORTH
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State | TX
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Zip | 76104-4142
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Country | US
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Telephone | 817-662-7044
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Fax | 817-438-1969
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Authorized Official
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Title or Position | DOCTOR
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Name | KHALILAH Q CLARKE
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Credential | MD
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Telephone | 817-662-7044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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