Individual
SHERYLL E CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD RD
Contact information
Practice address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 689-9251
(316) 689-9769
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9667
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
365
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719001
MEDICARE
—
05
—
200539620A
—
KS
Enumeration date
12/18/2007
Last updated
03/02/2017
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