Provider Demographics
NPI:1720234107
Name:CLARK-GANHEART, CECILY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILY
Middle Name:ANNE
Last Name:CLARK-GANHEART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2738
Mailing Address - Country:US
Mailing Address - Phone:269-209-2048
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 2028
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-6201
Practice Address - Fax:913-588-6271
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD040474207V00000X
OHABCDEFG1207V00000X
MO2015021377207VM0101X
KS0438153207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology