Provider Demographics
NPI:1194428516
Name:CLARKE, KENA ANTHONY (ORTHOPAEDIC TECH)
Entity type:Individual
Prefix:MR
First Name:KENA
Middle Name:ANTHONY
Last Name:CLARKE
Suffix:
Gender:M
Credentials:ORTHOPAEDIC TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2628
Mailing Address - Country:US
Mailing Address - Phone:954-857-9008
Mailing Address - Fax:
Practice Address - Street 1:4700 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-961-3500
Practice Address - Fax:954-961-1835
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-0212246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Single Specialty