Individual
MR. PHILLIP WAYNE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
11560 OLIVE BLVD, CREVE COEUR, MO 63141-7111
(314) 995-7128
(314) 995-7221
Mailing address
11560 OLIVE BLVD, CREVE COEUR, MO 63141-7111
(314) 995-7128
(314) 995-7221
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2014034806
MO
363LF0000X
Family Nurse Practitioner
Primary
AP 7468
AZ
363LF0000X
Family Nurse Practitioner
CNP-02553
NM
Other
Enumeration date
10/07/2014
Last updated
03/31/2026
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