Provider Demographics
NPI:1861621690
Name:CLARK, SHERRIE MARIE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1605
Mailing Address - Country:US
Mailing Address - Phone:816-332-7675
Mailing Address - Fax:
Practice Address - Street 1:1223 N 50TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1605
Practice Address - Country:US
Practice Address - Phone:816-332-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker