Active NPI
Glydene Faye Clark, M.D.
- Psychiatry Physician
- Kansas City, MO
National Provider Identifier
1558385823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- R2K78
- Practice address
- 4801 Linwood
Kansas City, MO 64128 - Phone
- (816) 922-2641
- Fax
- (816) 922-4452
- NPI assigned
- Jul 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | R2K78 | MO | Primary |
Addresses
Primary practice location
4801 Linwood
Kansas City, MO 64128
Mailing address
5179 W.114TH Place
Leawood, KS 66211
Phone (816) 861-4700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R2K78 | MO | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558385823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5179 W.114TH PLACE",
"city": "LEAWOOD",
"state": "KS",
"postal_code": "66211",
"telephone_number": "816-861-4700",
"fax_number": "816-922-4652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 LINWOOD",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "64128",
"telephone_number": "816-922-2641",
"fax_number": "816-922-4452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GLYDENE",
"middle_name": "FAYE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MO",
"license": "R2K78",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.