Clark, Mary Kathlyn

Clark, Mary Kathlyn is an individual health care provider with primary practice located at 620 C Congaree Rd , Greenville SC 29607. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Clark, Mary Kathlyn can be contacted via phone (864) 254-9477.

Contact Information

Primary practice address
620 C Congaree Rd Greenville SC 29607
Phone: (864) 254-9477
Fax: (864) 254-9896
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X APN1171 South Carolina

Profile Details

NPI number 1699846436
LBN Legal business name Clark, Mary Kathlyn
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2006
Last updated Apr 23rd, 2019 - about 7 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 1699846436 NPPES
South Carolina MEDICAID NP0553

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