Doctor Name: | DR. DESRA KAY CLARK |
NPI Number: | 1477816601 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 8200 Bryan Dairy Rd Suite 101 Largo, FL - 337771363 |
Business Phone Number: | 7275454444 |
Business Fax Number: | 7275455855 |
Mailing Address: | 8200 Bryan Dairy Rd, Suite 101 LARGO |
State: | FL |
Postal Code: | 337771363 |
Phone Number: | 7275454444 |
Fax Number: | 7275455855 |
NPI Enumeration Date: | 06/22/2012 |
NPI Last Update Date: | 06/22/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |