Individual
CHANNEL TRENISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
237 NW KESSLER DR APT 307, LEES SUMMIT, MO 64081-4173
(816) 289-1223
Mailing address
237 NW KESSLER DR APT 307, LEES SUMMIT, MO 64081-4173
(816) 289-1223
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2004022119
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2024039915
MO
Other
Enumeration date
10/18/2024
Last updated
10/18/2024
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