ANDREA CLARK (NPI# 1063863959) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063863959 |
| Entity Type | Individual |
| Full Name | ANDREA CLARK |
| Credential | RD, LD |
| Practice Address |
1 Childrens Pl Food and Nutrition Ls-15 Saint Louis MO 63110-1002 |
| Practice Telephone | 3144542648 |
| Practice Fax Number | 3144542557 |
| Mailing Telephone | 3144542648 |
| Mailing Fax Number | 3144542557 |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2016-06-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1004X |
Dietitian, Registered Specialization: Nutrition, Pediatric |
133VN1004X | MO | Dietary & Nutritional Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982182309 | Andrea K Clark | Occupational Therapist | 920 Goldenrod Ln, Hickman, NE 68372-9509 | 2018-07-30 |
| 1407238660 | Andrea Clark | Contractor | 2300 Seaman St, Apt. 101, Toledo, OH 43605-1952 | 2015-06-24 |
| 1114359049 | Andrea Clark | Physical Therapist | 531 Madison St, Albany, CA 94706-1116 | 2013-08-02 |
| 1003124223 | Andrea Nicole Clark | Licensed Practical Nurse | 9869 State Route 141, Kitts Hill, OH 45645-8649 | 2010-09-22 |
| 1295057362 | Andrea Serina Clark | Speech-Language Pathologist | 7497 Oak Tree Ln, Spring Hill, FL 34607-2324 | 2010-02-17 |
| 1336369602 | Andrea Walser Clark | Counselor | 157 Walser Way, Advance, NC 27006-7341 | 2007-04-27 |
| 1912034596 | Andrea Rachele Clark | Psychologist | 1818 W Lindsey St Ste C120, Norman, OK 73069-4169 | 2007-02-28 |
| 1477593580 | Andrea Clark | Counselor | 120 W 57th St, 8th Floor, New York, NY 10019-3320 | 2006-06-07 |
| 1558999672 | Andrea Clark | Registered Nurse | 1155 Dairy Ashford Rd Ste 560, Houston, TX 77079-3035 | 2020-04-01 |
| 1306359948 | Andrea Clark | Counselor | 10 Southard St, Trenton, NJ 08609-1020 | 2017-11-06 |
| Street Address |
1 CHILDRENS PL FOOD AND NUTRITION LS-15 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669476495 | William Lee Johnson | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2005-06-09 |
| 1114527033 | Kristin Kueper | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-29 |
| 1609474055 | Courtney Tompkins | Audiologist | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-16 |
| 1164036851 | Andrea Bumb | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-09-01 |
| 1235741513 | Shannon Ries | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1144832320 | Lacey Bender | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1699386417 | Kristen Bagby | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-14 |
| 1720696115 | Abigail Patricia Klatch | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-21 |
| 1518575422 | St Louis Childrens Hospital | Clinical Medical Laboratory | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-16 |
| 1730707068 | Alyssa Lavalle | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 133VN1004X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Pediatric |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114527033 | Kristin Kueper | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-29 |
| 1497390090 | Olivia Coates | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2019-11-07 |
| 1730732595 | Julia Reuter | Dietitian, Registered | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2019-07-22 |
| 1972087583 | Joshua Steven Werner | Dietitian, Registered | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2018-09-19 |
| 1386127397 | Kathleen Renee Carter | Dietitian, Registered | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2018-09-14 |
| 1124560073 | Christina Ward | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2016-11-09 |
| 1255873196 | Cynthia Rosen | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2016-11-09 |
| 1639611577 | Molly Mcnabb | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2016-11-09 |
| 1154863124 | Brandon Schramel | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2016-11-08 |
| 1063954030 | Rachel Verzola | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2016-11-08 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
Please comment or provide details below to improve the information on ANDREA CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.