| Doctor Name: | KRIS D CLARK |
| NPI Number: | 1154318624 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 600 |
| Business Practice Address: | 1260 Temple Ave Colonial Heights, VA - 238342984 |
| Business Phone Number: | 8045182597 |
| Business Fax Number: | 8045182598 |
| Mailing Address: | Po Box 758963, BALTIMORE |
| State: | MD |
| Postal Code: | 212758963 |
| Phone Number: | 8049685700 |
| Fax Number: | 8042177991 |
| NPI Enumeration Date: | 09/30/2005 |
| NPI Last Update Date: | 10/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 600 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |