Individual
TAMIKA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2811 VINE ST, KANSAS CITY, MO 64109-1339
(816) 405-0386
(510) 319-8402
Mailing address
2811 VINE ST, KANSAS CITY, MO 64109-1339
(816) 405-0386
(510) 319-8402
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2016041521
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730623141
—
MO
05
—
201153460C
—
KS
Enumeration date
12/05/2016
Last updated
05/08/2024
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