=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669386884
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACE CLERE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2026
-----------------------------------------------------
Last Update Date | 10/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3527 W TRUMAN BLVD STE 100A
-----------------------------------------------------
City | JEFFERSON CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65109-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-8910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3527 W TRUMAN BLVD STE 100A
-----------------------------------------------------
City | JEFFERSON CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65109-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-8910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2026041151
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------