Healthcare Provider Details

I. General information

NPI: 1669386884
Provider Name (Legal Business Name): GRACE CLERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 W TRUMAN BLVD STE 100A
JEFFERSON CITY MO
65109-5902
US

IV. Provider business mailing address

3527 W TRUMAN BLVD STE 100A
JEFFERSON CITY MO
65109-5902
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8910
  • Fax:
Mailing address:
  • Phone: 573-882-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026041151
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: