Individual
BEVERLY MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1004 E. MADISON ST, YATES CENTER, KS 66783-1314
(620) 625-2312
(620) 625-3560
Mailing address
309 SANDERS ST, BURLINGTON, KS 66839-2616
(620) 364-5395
(620) 364-8719
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-34503
KS
207Q00000X
Family Medicine Physician
94-07126
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200969130C
—
KS
Enumeration date
05/06/2009
Last updated
04/07/2016
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