Dr. Desra Kay Clark, D.O.
Family Medicine, Adult Medicine in Cocoa, FL. Individual provider (NPI-1).
NPI number1477816601
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1477816601
- Entity type
- Individual (NPI-1)
- Name
- Dr. Desra Kay Clark
- Credential
- D.O.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 22, 2012
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QA0505X | Family Medicine, Adult Medicine | OS12364 | FL | Yes |
Other names
- Desra Kay Kiely (Former Name)
Practice location
7227 N Us Highway 1Cocoa, FL 32927-5020
Phone 321-877-2740 · Fax 321-877-2793
Mailing address
Po Box 1137Melbourne, FL 32902-1137
Phone 321-952-9696 · Fax 321-952-7937
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