Individual
MS. JOAN MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
6400 CLAYTON RD STE 302, SAINT LOUIS, MO 63117-1850
(314) 645-3370
(314) 645-0576
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-1019
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2816742621
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060065
EXCLUSIVE CHOICE
MO
01
—
072280
PROVIDER NUMBER
—
01
—
213137
BLUE CHOICE
MO
05
—
428933303
—
MO
01
—
500005275
RAILROAD MEDICARE
MO
01
—
534842
HEALTHLINK
MO
Enumeration date
11/17/2005
Last updated
10/20/2020
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