Clark, Lyreva J
Clark, Lyreva J is an individual health care provider with primary practice located at 6500 Hospital Dr , Hannibal MO 63401-6890. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Clark, Lyreva J can be contacted via phone (573) 629-3400.Contact Information
Primary practice address
6500 Hospital Dr
Hannibal MO 63401-6890
Phone: (573) 629-3400
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 2003005715 | Missouri |
Profile Details
| NPI number | 1548246747 |
|---|---|
| LBN Legal business name | Clark, Lyreva J |
| Credentials | RNFNP-C |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 20th, 2005 |
| Last updated | Sep 28th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548246747 | NPPES |
| Missouri | MEDICAID | 429238306 |
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