Individual
AMIE MELISSA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
13515 BARRETT PARKWAY DR, SUITE 170, BALLWIN, MO 63021-5870
(314) 775-2811
Mailing address
3975 WILMINGTON AVE, APT A, SAINT LOUIS, MO 63116-3250
(314) 280-8157
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.389801
IL
367500000X
Certified Registered Nurse Anesthetist
086232
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
2016017057
MO
Other
Enumeration date
01/31/2011
Last updated
04/25/2017
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