DESIRAE CLARK


Address: 5100 Lydia Ave, Kansas City, MO 64110-2608
Phone: 8267499147

DESIRAE CLARK (NPI# 1477100717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1477100717
Entity Type Individual
Full Name DESIRAE CLARK
Practice Address 5100 Lydia Ave
Kansas City
MO 64110-2608
Mailing Address Po Box 300564
Kansas City
MO 64130-0564
Practice Telephone 8267499147
Mailing Telephone 8167499147
Enumeration Date 2019-08-21
Last Update Date 2019-08-21
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 335E00000X Prosthetic/Orthotic Supplier Suppliers

Office Location

Street Address 5100 LYDIA AVE
City KANSAS CITY
State MO
Zip Code 64110-2608

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1093088007 Amanda Kinsey Speech-Language Pathologist 4848 Woodland Ave, Kansas City, MO 64110 2012-02-22
1952612673 Braxton Baker Speech-Language Pathologist 4341 Locust St, Kansas City, MO 64110 2010-06-28
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Taxonomy Information

Taxonomy Code 335E00000X
Grouping Suppliers
Classification Prosthetic/Orthotic Supplier

Taxonomy Definition

An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1215400312 Cranial Technologies, Inc. Prosthetic/Orthotic Supplier 4801 Main St Ste 220, Kansas City, MO 64112-2929 2019-01-10
1952760860 Vernice Lynn Johnson Prosthetic/Orthotic Supplier 4027 E 45th St, 1658 E. 63rd Street, Kansas City, MO 64131-2125 2016-02-19
1073716304 Footworks Inc. Prosthetic/Orthotic Supplier 1152 W 103rd St, Kansas City, MO 64114-4511 2007-06-06
1043315641 Restored Images Inc Prosthetic/Orthotic Supplier 4116 Ne Vivion Rd, Kansas City, MO 64119-2811 2006-09-14
1295735090 Highland Nursing and Rehabilitation Center, LLC Prosthetic/Orthotic Supplier 904 E 68th St, Kansas City, MO 64131-1305 2005-07-22
1386105948 Capitol Orthopedic Inc Prosthetic/Orthotic Supplier 4001 Blue Pkwy Ste 98, Kansas City, MO 64130-2315 2019-03-27
1700896958 Saint Luke's Hospital of Kansas City Prosthetic/Orthotic Supplier 4321 Washington St, Suite 4000, Kansas City, MO 64111-5961 2006-08-09

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1497355689 Hair On The Edge Prosthetic/Orthotic Supplier 9708 Lackland Rd, Overland, MO 63114-3414 2020-10-28
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1437783776 Mager & Gougelman of St. Louis, LLC Prosthetic/Orthotic Supplier 1034 S Brentwood Blvd Ste 1880, Richmond Heights, MO 63117-1218 2020-02-25
1962042440 Fourroux Prosthetics, Inc Prosthetic/Orthotic Supplier 9665 Page Avenue, Overland, MO 63132 2020-01-13
1407496201 Ortheco LLC Prosthetic/Orthotic Supplier 2907 Independence St Ste D, Cape Girardeau, MO 63703-5027 2020-01-09
1720540313 Axes Physical Therapy, LLC Prosthetic/Orthotic Supplier 754 Luetkenhaus Blvd, Wentzville, MO 63385-3515 2019-04-02
1093272460 Axes Physical Therapy I, LLC Prosthetic/Orthotic Supplier 2018 Phoenix Center Dr, Washington, MO 63090-5544 2019-02-21
1649778382 Boston Brace International Inc. Prosthetic/Orthotic Supplier 50 Crestwood Executive Ctr Ste 315, Saint Louis, MO 63126-1900 2018-01-29
1356858971 Monique Renee Wigs and Etc Prosthetic/Orthotic Supplier 12123 Blue Ridge Ext Ste C, Grandview, MO 64030-1194 2018-01-04
1841732716 Ann's Lingerie and Mastectomy Center Prosthetic/Orthotic Supplier 623 S Silver Springs Rd, Cape Girardeau, MO 63703-7500 2016-11-09
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Competitor

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City KANSAS CITY
Zip Code 64110

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Dataset Information

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.

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