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General NPI Number Information
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NPI Number | 1841557428
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Entity Type | Individual
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Provider Name | KATHERINE CLARK CPNP
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Gender | Female
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 650 CLARK WAY
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City | PALO ALTO
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State | CA
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Zip | 94304
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Country | US
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Telephone | 650-688-3644
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Fax | 650-688-3669
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Provider Business Mailing Address
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Address Line | 650 CLARK WAY
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City | PALO ALTO
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State | CA
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Zip | 94304
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Country | US
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Telephone | 650-688-3644
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Fax | 650-688-3669
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5005585
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License Number State | NC
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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 | 5005585
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 23185
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License Number State | CA
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