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General NPI Number Information
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NPI Number | 1831642438
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Entity Type | Individual
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Provider Name | KATHRYN JANE CLARKE
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Gender | Female
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Dates
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Enumeration Date | 07/31/2016
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 374 GRAND AVE
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City | NEW HAVEN
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State | CT
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Zip | 06513-3733
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Country | US
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Telephone | 206-512-6556
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Fax |
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Provider Business Mailing Address
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Address Line | 374 GRAND AVE BLDG B
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City | NEW HAVEN
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State | CT
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Zip | 06513-3733
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Country | US
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Telephone | 703-777-7411
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Fax | 203-974-0128
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN 60141168
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024175369
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001275652
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 227652
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 14226
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License Number State | CT
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