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Individual
STEPHANIE CLARK
Active
Individual
STEPHANIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2011004525
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2022026857
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
G170123
IA
Other
Enumeration date
10/09/2014
Last updated
12/02/2022
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