Provider Demographics
NPI:1871009068
Name:CLARY, SHARLENE MARIE (RT(R)(M)(CT)(MR))
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:MARIE
Last Name:CLARY
Suffix:
Gender:F
Credentials:RT(R)(M)(CT)(MR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25112 W 83RD TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-3101
Mailing Address - Country:US
Mailing Address - Phone:913-240-6127
Mailing Address - Fax:
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2778672085B0100X
KS22-049922085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS22-04992OtherKANSAS STATE BOARD OF HEALING ARTS
277867OtherARRT