Individual
DR. NICHOLAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Mailing address
2401 GILLHAM RD, ATTN PROVIDER ENROLLMENT DEPT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2013017446
MO
208M00000X
Hospitalist Physician
0437936
KS
208M00000X
Hospitalist Physician
Primary
2013017446
MO
Other
Enumeration date
06/24/2011
Last updated
02/24/2026
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