Individual
KELLY ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3202 MILLER ST, BETHANY, MO 64424-2713
(660) 425-3154
(660) 425-6663
Mailing address
3202 MILLER ST, BETHANY, MO 64424-2713
(660) 425-3154
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2020000768
MO
363LF0000X
Family Nurse Practitioner
Primary
2020000768
MO
Other
Enumeration date
01/09/2020
Last updated
03/18/2021
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