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General NPI Number Information
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NPI Number | 1821489337
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Entity Type | Individual
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Provider Name | KENDALL CLARK FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 715 W OGEECHEE ST
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City | SYLVANIA
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State | GA
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Zip | 30467-8693
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Country | US
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Telephone | 912-451-4100
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Fax | 912-451-4105
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | SYLVANIA
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State | GA
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Zip | 30467-0194
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Country | US
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Telephone | 912-451-4100
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Fax | 912-531-7465
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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 | RN209683
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License Number State | GA
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