Provider Demographics
NPI:1255565560
Name:CLEMENS, KAREN MYOSHI (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MYOSHI
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 EASTON CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3258
Mailing Address - Country:US
Mailing Address - Phone:816-792-5428
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:TRUMED CLINIC
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-2084
Practice Address - Fax:816-404-3943
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOA0309283363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO402000001Medicare PIN