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Individual

RIKI LEE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
1675 E SEMINOLE ST STE A1, SPRINGFIELD, MO 65804-2454
(417) 557-2355
Mailing address
396 MAYNARD RD, NIXA, MO 65714-7267
(417) 880-9481

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2014029277
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2022042624
MO

Other

Enumeration date
10/11/2022
Last updated
06/24/2025
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