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General NPI Number Information
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NPI Number | 1285714113
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Entity Type | Individual
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Provider Name | JODY S TOERBER-CLARK FNP PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 904 5TH STREET PROVIDER ENROLLMENT
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City | WAMEGO
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State | KS
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Zip | 66547-4619
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Country | US
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Telephone | 785-456-9773
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Fax | 785-456-1432
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Provider Business Mailing Address
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Address Line | 904 5TH STREET PROVIDER ENROLLMENT
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City | WAMEGO
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State | KS
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Zip | 66547
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Country | US
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Telephone | 785-456-9773
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Fax | 785-456-1432
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 45326
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 45326
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License Number State | KS
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