Individual
KATHRYN S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2000
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
113954
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427479605
—
MO
Enumeration date
08/23/2006
Last updated
05/16/2013
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