| Doctor Name: | SHERILYN K CLARK |
| NPI Number: | 1467533604 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 054701 |
| Business Practice Address: | 110 S. 2nd St. Ellington, MO - 63638 |
| Business Phone Number: | 5736632313 |
| Business Fax Number: | 5736632441 |
| Mailing Address: | 108 Pine Lane, VAN BUREN |
| State: | MO |
| Postal Code: | 63965 |
| Phone Number: | 5733238264 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA2000X |
| License Number: | 054701 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Administrator |
| Taxonomy Definition: | |