Provider Demographics
NPI:1497583587
Name:CLARK, KARA JANELLE
Entity type:Individual
Prefix:MISS
First Name:KARA
Middle Name:JANELLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 COVERSTONE HILL CIR APT 433
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7531
Mailing Address - Country:US
Mailing Address - Phone:240-490-6698
Mailing Address - Fax:
Practice Address - Street 1:12000 COVERSTONE HILL CIR APT 433
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7531
Practice Address - Country:US
Practice Address - Phone:240-490-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach