Clark, Brian Kelly

Clark, Brian Kelly is an individual health care provider with primary practice located at 501 Medical Dr , Hampton VA 23666-6080. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Clark, Brian Kelly can be contacted via phone (703) 295-9360.

Contact Information

Primary practice address
501 Medical Dr Hampton VA 23666-6080
Phone: (703) 295-9360
Fax: (703) 295-9369
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 0024165065 Virginia

Profile Details

NPI number 1821059403
LBN Legal business name Clark, Brian Kelly
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Mar 8th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821059403 NPPES
Virginia MEDICAID 010170699

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