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General NPI Number Information
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NPI Number | 1003379769
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Entity Type | Individual
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Provider Name | BRADY CLARK
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Gender | Male
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 1750 INDEPENDENCE AVE
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City | KANSAS CITY
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State | MO
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Zip | 64106-1453
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Country | US
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Telephone | 816-654-7000
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Fax |
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Provider Business Mailing Address
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Address Line | W2390 COUNTY ROAD I
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City | MARKESAN
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State | WI
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Zip | 53946-7502
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Country | US
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Telephone | 920-295-2552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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