Clark, Kristen J.
Clark, Kristen J. is an individual health care provider with primary practice located at 1856-14 Thompson Bridge Rd , Gainesville GA 30501-1663. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Clark, Kristen J. can be contacted via phone (770) 534-2800.Contact Information
Primary practice address
1856-14 Thompson Bridge Rd
Gainesville GA 30501-1663
Phone: (770) 534-2800
Fax: (770) 534-2889
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 004548 | Georgia |
Profile Details
| NPI number | 1578527545 |
|---|---|
| LBN Legal business name | Clark, Kristen J. |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2006 |
| Last updated | May 27th, 2009 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578527545 | NPPES |
| Georgia | MEDICAID | 613657510A |
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