Kelly Ann Clark
Nurse Practitioner, Family in Bethany, MO. Individual provider (NPI-1).
NPI number1164062972
StatusActive
Last updated in NPPESMar 18, 2021
Details
- NPI
- 1164062972
- Entity type
- Individual (NPI-1)
- Name
- Kelly Ann Clark
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 9, 2020
- Certification date
- Mar 18, 2021
- Last updated
- Mar 18, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 2020000768 | MO | Yes |
| 207Q00000X | Family Medicine | 2020000768 | MO |
Practice location
3202 Miller StBethany, MO 64424-2713
Phone 660-425-3154 · Fax 660-425-6663
Mailing address
3202 Miller StBethany, MO 64424-2713
Phone 660-425-3154
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Family Nurse Practitioner providers in Bethany, MO
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All 7 Family Nurse Practitioner providers in Bethany · All 101 providers in Bethany
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