Healthcare Provider Details

I. General information

NPI: 1225882426
Provider Name (Legal Business Name): MS. SHEREECE SHANIKA CLARKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 09/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HEALTH-TRUMAN MEDICAL CENTER 2301 HOLMES ST
KANSAS CITY MO
64108
US

IV. Provider business mailing address

UNIVERSITY HEALTH-TRUMAN MEDICAL CENTER 2301 HOLMES ST
KANSAS CITY MO
64108
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-0886
  • Fax: 816-404-0888
Mailing address:
  • Phone: 816-404-0886
  • Fax: 816-404-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: