Provider Demographics
NPI:1528486172
Name:CLARK, RHONDA IDDINS (FNP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:IDDINS
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:IDDINS
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1402 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3104
Mailing Address - Country:US
Mailing Address - Phone:760-326-0222
Mailing Address - Fax:760-326-0221
Practice Address - Street 1:1402 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3104
Practice Address - Country:US
Practice Address - Phone:760-326-0222
Practice Address - Fax:760-326-0221
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18691363LF0000X
KY3009621363LF0000X
AZ240243363LF0000X
CA95006850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily