Provider Demographics
NPI:1902560600
Name:CLARK, KARA (HOME HEALTH AGENCY)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:HOME HEALTH AGENCY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8177 REAL QUIET LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9168
Mailing Address - Country:US
Mailing Address - Phone:614-558-6657
Mailing Address - Fax:
Practice Address - Street 1:8177 REAL QUIET LN
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9168
Practice Address - Country:US
Practice Address - Phone:614-558-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide