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General NPI Number Information
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NPI Number | 1114924149
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Entity Type | Individual
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Provider Name | RYAN N. CLARK MS, ATC/R, CSCS
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Gender | Male
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1931 BURLINGTON ST
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-3407
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Country | US
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Telephone | 816-241-2131
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Fax | 816-241-0551
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Provider Business Mailing Address
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Address Line | 8804 NE 73RD TER
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City | KANSAS CITY
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State | MO
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Zip | 64158-1088
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Country | US
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Telephone | 816-781-0270
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2003022245
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License Number State | MO
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