MEDICARE: KAMILA CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1640123	CO
2	163WC0200X	Critical Care Medicine Registered Nurse	1001115067	CA

General Provider Information

NPI Number	:	1851846596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMILA CLARK

Provider Business Mailing Address
First Line	:	7171 S CHEROKEE TRL
Second Line	:	2232
City	:	AURORA
State	:	CO
Zip	:	80016-2287
Country	:	US
Telephone Number	:	818-429-1070
Fax Number	:

Provider Business Practice Location Address
First Line	:	7171 S CHEROKEE TRL
Second Line	:	2232
City	:	AURORA
State	:	CO
Zip	:	80016-2287
Country	:	US
Telephone Number	:	818-429-1070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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Directions to “ KAMILA CLARK ” Practice Location

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