Provider Demographics
NPI:1285103762
Name:CLARK, KRISTIN C (RPA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:C
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:C
Other - Last Name:HARTPENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-6515
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000020243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant