Lyreva J Clark, RNFNP-C
Individual provider Active NPI Family Nurse Practitioner · Hannibal, MO
NPI 1548246747 · NPPES record last updated Sep 28, 2022
Key facts
- NPI
- 1548246747
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2003005715 (MO)
- Practice address
- 6500 Hospital Dr
Hannibal, MO 63401-6890 - Phone
- (573) 629-3400
- NPI assigned
- Dec 20, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hannibal Regional Healthcare System, Inc | Past | Accepting new patients |
Interoperability endpoints
- lyrevaclark@hrmg.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2003005715 | MO | Yes |
Addresses
Primary practice location
6500 Hospital Dr
Hannibal, MO 63401-6890
Mailing address
PO Box 551
Hannibal, MO 63401-0551
Phone (573) 588-4134
Other practice location 1
400 S Center St
Shelbina, MO 63468-1404
Phone (573) 588-4131
Other practice location 2
3650 Stardust Dr
Hannibal, MO 63401-2411
Phone (573) 231-0660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 429238306 | Medicaid | MO |
Other names
- Lyreva J Nollette
Other providers in Hannibal, MO
- Chicago Hearing LLC
- Robin K Christal
- Beverly Ann Christy
- Jill Marie Clark
- Lyle Arthur Clark
- Edward A Cline
- Jane A Cline
- Steven N. Cockrell
- Savannah J Coelho
- David Alex Coffey
All providers in Hannibal, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.