Provider Demographics
NPI:1497565360
Name:HAMBLY-CLARK, ALEXANDRA L
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:HAMBLY-CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MO
Mailing Address - Zip Code:63435-1647
Mailing Address - Country:US
Mailing Address - Phone:660-229-1204
Mailing Address - Fax:
Practice Address - Street 1:409 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MO
Practice Address - Zip Code:63435-1647
Practice Address - Country:US
Practice Address - Phone:660-229-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program