Kelly Patricia Clark, LPN
Individual provider Active NPI Licensed Practical Nurse · Mason, MI
NPI 1013474410 · NPPES record last updated Feb 22, 2019
Key facts
- NPI
- 1013474410
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 4703110786 (MI)
- Practice address
- 55 Pine Dr E
Mason, MI 48854-9229 - Phone
- (517) 394-6484
- NPI assigned
- Feb 22, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4703110786 | MI | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 4703110786 | MI | Yes |
Addresses
Primary practice location
55 Pine Dr E
Mason, MI 48854-9229
Mailing address
55 Pine Dr E
Mason, MI 48854-9229
Phone (517) 394-6484
Other providers in Mason, MI
- Sin Chu
- Sherry Catherine Cipriano
- Patrice Cisco
- CJT Solutions
- Christie Clark
- Edward A Clarke
- Kendra Coates
- Margo Undraye Collins
- John Mitchell Combs
- Consumer Services Inc
All providers in Mason, MI · Licensed Practical Nurse in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.