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General NPI Number Information
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NPI Number | 1124902309
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Entity Type | Individual
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Provider Name | KRISTEN CLARK
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Gender | Female
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 122 OKATIE CENTER BLVD N STE 240
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City | OKATIE
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State | SC
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Zip | 29909-3782
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Country | US
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Telephone | 843-832-7925
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CHESTNUT ST
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City | BEAUFORT
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State | SC
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Zip | 29906-2414
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Country | US
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Telephone | 803-508-3043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 30794
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License Number State | SC
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