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Individual

BREANNA FAITH CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, FPMHNP

Contact information

Practice address
17844 E 23RD ST S, INDEPENDENCE, MO 64057-1840
(816) 254-3652
Mailing address
PO BOX 844715, KANSAS CITY, MO 64184-4715
(417) 761-5000

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2018002924
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2021023279
MO

Other

Enumeration date
03/23/2021
Last updated
06/05/2025
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