Individual
KATHRYN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9556 MANCHESTER RD, SAINT LOUIS, MO 63119-1313
(314) 373-5740
Mailing address
4043 SEQUOIA DR, EDWARDSVILLE, IL 62025-7711
(636) 222-2282
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.010325
IL
363A00000X
Physician Assistant
Primary
2024007412
MO
Other
Enumeration date
01/03/2023
Last updated
06/13/2025
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