Provider Demographics
NPI:1912947284
Name:CLARK, BARBARA J (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:CLARK
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:250 NE MULBERRY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4533
Mailing Address - Country:US
Mailing Address - Phone:816-389-4130
Mailing Address - Fax:816-389-4140
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-389-4130
Practice Address - Fax:816-389-4140
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO047721367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO912676244Medicaid
MO17957064OtherMO BCBS NUMBER
MO430046022OtherMO RR MEDICARE NUMBER
MO100249760BMedicaid
MOJ226615Medicare PIN