Provider Demographics
NPI:1972927838
Name:CLARK, KAMESHA LYNN (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:KAMESHA
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:KAMESHA
Other - Middle Name:LYNN
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2683 COBBLE CIR
Mailing Address - Street 2:#5
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-5162
Mailing Address - Country:US
Mailing Address - Phone:937-304-7279
Mailing Address - Fax:
Practice Address - Street 1:2683 COBBLE CIR
Practice Address - Street 2:#5
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-5162
Practice Address - Country:US
Practice Address - Phone:937-304-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH396749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse