| Doctor Name: | KELLY CLARK |
| NPI Number: | 1245566272 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 6100 Radio Station Road Laplata, MD - 20646 |
| Business Phone Number: | 3016099887 |
| Business Fax Number: | 3016097284 |
| Mailing Address: | Po Box 2924, LA PLATA |
| State: | MD |
| Postal Code: | 206462984 |
| Phone Number: | 3016099887 |
| Fax Number: | 3016097284 |
| NPI Enumeration Date: | 10/27/2009 |
| NPI Last Update Date: | 10/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171M00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Case Manager/Care Coordinator |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee |