Provider Demographics
NPI:1588267066
Name:CLARK, KIMBERLY NACOLE (APRN, FNP-BC, NP-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NACOLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HILLS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30178-2051
Mailing Address - Country:US
Mailing Address - Phone:770-684-8700
Mailing Address - Fax:
Practice Address - Street 1:48 HILLS CREEK RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30178-2051
Practice Address - Country:US
Practice Address - Phone:770-684-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily