Individual
DR. AMY LYNN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5648
(314) 268-6448
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5648
(314) 268-6448
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2012016489
MO
2080P0205X
Pediatric Endocrinology Physician
Primary
2012016489
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IL
Enumeration date
06/14/2009
Last updated
07/08/2021
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