NPI 1477100717
Desirae Clark
Practice location
- Address
- 5100 Lydia Ave, Kansas City, MO 64110-2608
- Phone
- (826) 749-9147
- Mailing address
- PO Box 300564, Kansas City, MO 64130-0564
Registered specialties
Prosthetic/Orthotic Supplier
Primary
Registry record
- NPI
- 1477100717
- Entity type
- Individual
- Sex (as registered)
- Female
- NPI issued
- 21 Aug 2019
- Record last updated
- 21 Aug 2019
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.