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NPI Code Detail

MEDICARE: MRS. KARLA DENISE CLUBINE FNP/PNP

MEDICARE: MRS. KARLA DENISE CLUBINE FNP/PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner128465MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265423461
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KARLA DENISE CLUBINE FNP/PNP
Provider Business Mailing Address
First Line : 22320 HIGHWAY M
Second Line :
City : BRUNSWICK
State : MO
Zip : 65236-2205
Country : US
Telephone Number : 660-272-3332
Fax Number :
Provider Business Practice Location Address
First Line : 130 E LOCKLING ST
Second Line :
City : BROOKFIELD
State : MO
Zip : 64628-2337
Country : US
Telephone Number : 660-258-1050
Fax Number : 660-258-1052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 12/05/2008

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