Provider Demographics
NPI:1023033560
Name:CLARK, ANNE S (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10500 BARKLEY ST STE 220
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1838
Mailing Address - Country:US
Mailing Address - Phone:913-738-9235
Mailing Address - Fax:913-738-9285
Practice Address - Street 1:10500 BARKLEY ST STE 220
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1838
Practice Address - Country:US
Practice Address - Phone:913-738-9235
Practice Address - Fax:913-738-9285
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-228382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0009695Medicare ID - Type Unspecified
KSF64891Medicare UPIN