Provider Demographics
NPI:1023455714
Name:CLARK, LAURA D (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 N NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4306
Mailing Address - Country:US
Mailing Address - Phone:417-837-4000
Mailing Address - Fax:417-875-4710
Practice Address - Street 1:1301 E SUNSHINE ST STE 118
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1152
Practice Address - Country:US
Practice Address - Phone:417-207-2441
Practice Address - Fax:417-281-3559
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013019734363LF0000X
MO2001017661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily