Clark, Wanda Kaye

Clark, Wanda Kaye is an individual health care provider with primary practice located at 1151 Camden Ave , Rock Hill SC 29732-3014. 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, Wanda Kaye can be contacted via phone (803) 909-6363.

Contact Information

Primary practice address
1151 Camden Ave Rock Hill SC 29732-3014
Phone: (803) 909-6363
Fax: (803) 909-6364
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 1484 South Carolina

Profile Details

NPI number 1043213457
LBN Legal business name Clark, Wanda Kaye
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Jul 9th, 2007 - about 18 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 1043213457 NPPES
South Carolina MEDICAID GP3059

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