Provider Demographics
NPI:1669443503
Name:CLARK, TOSHALENE (FNP)
Entity Type:Individual
Prefix:
First Name:TOSHALENE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 S US HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9317
Mailing Address - Country:US
Mailing Address - Phone:816-532-7015
Mailing Address - Fax:816-532-7017
Practice Address - Street 1:601 S US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-9317
Practice Address - Country:US
Practice Address - Phone:816-532-7015
Practice Address - Fax:816-532-7017
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCNP-117726363LF0000X
MOMORN117726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily