Individual
ANDREW BENJAMIN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
10700 NALL AVE, OVERLAND PARK, KS 66211-1206
(912) 574-1908
Mailing address
1138 E MAIN ST, ANTHONY, KS 67003-2706
(620) 842-2475
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2023035873
MO
2255A2300X
Athletic Trainer
Primary
24-01693
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200054219
CERTIFIED ATHLETIC TRAINER
—
Enumeration date
01/13/2023
Last updated
01/12/2025
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