Individual
MR. RICHARD D CLARK
Active
Individual
MR. RICHARD D CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN ARNP CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
134677
MO
163W00000X
Registered Nurse
1484659051
KS
363L00000X
Nurse Practitioner
54725
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
09.006191
IL
367500000X
Certified Registered Nurse Anesthetist
134677
MO
367500000X
Certified Registered Nurse Anesthetist
54725
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001771600
COMMUNITY HEALTH PLAN
—
01
—
100385650C
KANSAS MEDICAL ASSISTISTA
—
01
—
161280
BCBS OF KANSAS
—
01
—
27862039
BCBS OF KANSAS CITY
—
01
—
481192875
HUMANA
—
05
—
915697213
—
MO
01
—
P00155221
RR MEDICARE
—
01
—
P13178
PREMIER HEALTH PLANS
—
Enumeration date
11/30/2005
Last updated
05/21/2010
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