Healthcare Provider Details

I. General information

NPI: 1518654482
Provider Name (Legal Business Name): CLARE K DEVINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N STURGEON ST
MONTGOMERY CITY MO
63361-1829
US

IV. Provider business mailing address

2411 HOLMES ST
KANSAS CITY MO
64108-2741
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-2990
  • Fax:
Mailing address:
  • Phone: 816-235-5412
  • Fax: 816-235-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2024034186
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: