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:
Health care specialties
Specialty | Code | License # | 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 17 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 | 1043213457 | NPPES |
South Carolina | MEDICAID | GP3059 |
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