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General NPI Number Information
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NPI Number | 1427858992
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Entity Type | Individual
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Provider Name | REBECCA KLARK
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Gender | Female
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 3737 SOUTHERN BLVD STE 3000A
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City | KETTERING
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State | OH
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Zip | 45429-1262
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Country | US
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Telephone | 937-433-2051
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Fax |
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Provider Business Mailing Address
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Address Line | 8972 WILMINGTON RD
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City | OREGONIA
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State | OH
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Zip | 45054-9439
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Country | US
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Telephone | 937-207-6932
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN.CNP.0038871
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License Number State | OH
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