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General NPI Number Information
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NPI Number | 1932575743
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Entity Type | Individual
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Provider Name | KERRY CLARK AGNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2015
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVENUE, SUITE 305 & 500
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1306
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Country | US
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Telephone | 703-988-4683
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Fax |
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL ST SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | RN1038780
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024178999
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024178999
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 0024178999
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License Number State | VA
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