| Doctor Name: | KELLY S CLARK |
| NPI Number: | 1538479324 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPN |
| License Number: | 131431 |
| Business Practice Address: | 15716 W High St # 597 Middlefield, OH - 440629201 |
| Business Phone Number: | 4406328071 |
| Business Fax Number: | |
| Mailing Address: | 15716 W High St, P O Box 597 MIDDLEFIELD |
| State: | OH |
| Postal Code: | 440629201 |
| Phone Number: | 4406328071 |
| Fax Number: | |
| NPI Enumeration Date: | 10/14/2010 |
| NPI Last Update Date: | 10/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 164X00000X |
| License Number: | 131431 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Licensed Vocational Nurse |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states. |