Individual
BARBARA J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
19550 E 39TH ST S, SUITE 100, INDEPENDENCE, MO 64057-2303
(816) 389-4130
(816) 389-4140
Mailing address
250 NE MULBERRY ST, SUITE 202, LEES SUMMIT, MO 64086-4533
(816) 389-4130
(816) 389-4140
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
047721
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100249760B
—
MO
01
—
17957064
MO BCBS NUMBER
MO
01
—
430046022
MO RR MEDICARE NUMBER
MO
05
—
912676244
—
MO
Enumeration date
06/07/2006
Last updated
02/25/2009
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