Clark, Beverly Marie

Clark, Beverly Marie is an individual health care provider with primary practice located at 1004 E. Madison St , Yates Center KS 66783-1314. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Clark, Beverly Marie can be contacted via phone (620) 625-2312.

Contact Information

Primary practice address
1004 E. Madison St Yates Center KS 66783-1314
Phone: (620) 625-2312
Fax: (620) 625-3560
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 04-34503 Kansas
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 94-07126 Kansas

Profile Details

NPI number 1649404625
LBN Legal business name Clark, Beverly Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 6th, 2009
Last updated Apr 7th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649404625 NPPES
Kansas MEDICAID 200969130C

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