Provider Demographics
NPI:1679118426
Name:CLARK, EVA (WHNP)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:CLARK
Suffix:
Gender:
Credentials:WHNP
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:TILFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 S CLAIRBORNE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 S CLAIRBORNE RD STE 104
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1744
Practice Address - Country:US
Practice Address - Phone:913-648-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019023253207V00000X, 363LW0102X
KS79124363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology