Lyreva J Clark, RNFNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2003005715 Issued in MO

Practice address

6500 Hospital Dr
Hannibal, MO 63401-6890

Phone

(573) 629-3400

NPI assigned

Dec 20, 2005

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lyreva J Nollette Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lyrevaclark@hrmg.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hannibal Regional Healthcare System, Inc

  dba Hannibal Regional Hospital Home Health Agency

  • Home Health Agency
  • Hannibal, MO
  • NPI 1992726731
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1548246747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634010551",
            "telephone_number": "573-588-4134",
            "fax_number": "573-588-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 HOSPITAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016890",
            "telephone_number": "573-629-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 S Center St",
            "address_purpose": "LOCATION",
            "city": "Shelbina",
            "state": "MO",
            "postal_code": "634681404",
            "country_code": "US",
            "telephone_number": "573-588-4131",
            "fax_number": "573-588-4876",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3650 Stardust Dr",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "634012411",
            "country_code": "US",
            "telephone_number": "573-231-0660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LYREVA",
        "middle_name": "J",
        "credential": "RNFNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-20",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2003005715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429238306",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYREVA",
            "last_name": "NOLLETTE",
            "middle_name": "J",
            "credential": "RNFNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chicago Hearing LLC (Miracle Ear)
• Robin K Christal, LPC
• Beverly Ann Christy, FNP-C
• Jill Marie Clark, MS, RD, LD
• Lyle Arthur Clark, M.D.
• Edward A Cline, DPM
• Jane A Cline, PT
• Steven N. Cockrell, M.D.
• Savannah J Coelho, PLPC
• David Alex Coffey, MD

• Family Nurse Practitioner in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.