Individual
DR. KENDELL C. CLARKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 N KENTUCKY AVE, WEST PLAINS, MO 65775-2029
(417) 257-5800
(417) 257-5999
Mailing address
PO BOX 1100, WEST PLAINS, MO 65775-1100
(417) 257-5800
(417) 269-2492
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
110746
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128195
BLUE CROSS MO
—
05
—
1922116284
—
MO
05
—
208633001
—
AR
05
—
208922419
—
MO
Enumeration date
08/28/2006
Last updated
07/21/2022
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