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General NPI Number Information
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NPI Number | 1164349940
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Entity Type | Individual
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Provider Name | KRISTY ANN CLARK
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Gender | Female
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 201 HOSPITAL DR
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City | DOVER
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State | OH
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Zip | 44622-2058
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Country | US
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Telephone | 330-343-6631
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Fax | 234-801-4374
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Provider Business Mailing Address
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Address Line | 3232 DOWNING ST SW LOT 70
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City | EAST SPARTA
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State | OH
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Zip | 44626-9741
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Country | US
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Telephone | 330-321-3042
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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 | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 2607870
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License Number State | OH
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