Breanna Faith Clark, MSN, FPMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Independence, MO
NPI 1962088559 · NPPES record last updated Jul 30, 2026
Key facts
- NPI
- 1962088559
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2021023279 (MO)
- Practice address
- 14310 E 42ND St S
Independence, MO 64055-7308 - Phone
- (816) 254-3652
- NPI assigned
- Mar 23, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Burrell Inc
Practice addresses (Care Compare)
17844 E 23Rd St
Burrell Behavioral Health
Independence, MO 64057-1840
Phone (816) 254-3652
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210728002655 | MO | Practitioner - Nurse Practitioner | 3173926151 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018002924 | MO | MD | Registered Nurse |
| 2021023279 | MO | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preferred Family Healthcare, Inc. | Current |
Accepting new patients | |
| Burrell, Inc. | Current |
Accepting new patients | |
| Preferred Family Healthcare, Inc | Current |
Accepting new patients | |
| Burrell, Inc. | Current |
Accepting new patients |
Locations
1805 E Walnut St
Columbia, MO 65201
Phone (573) 777-7500
17611 E US Highway 24
Independence, MO 64056
Phone (816) 836-6350
17844 E 23rd St S
Independence, MO 64057
Phone (816) 257-9716
4231 S Hocker Dr
Independence, MO 64055
Phone (816) 350-3103
210 Hoover Rd
Jefferson City, MO 65109
Phone (573) 632-4321
7447 Holmes Rd
Kansas City, MO 64131
Phone (816) 569-6360
900 E Laharpe St
Kirksville, MO 63501
4066 Dunnica Ave
Saint Louis, MO 63116
Phone (314) 361-1630
2885 W Battlefield St
Springfield, MO 65807
Phone (417) 761-5214
1300 E Bradford Pkwy
#H
Springfield, MO 65804
1300 E Bradford Pkwy
Springfield, MO 65804
Phone (417) 269-5400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2021023279 | MO | Yes |
| Registered Nurse | 163W00000X | 2018002924 | MO |
Addresses
Primary practice location
14310 E 42ND St S
Independence, MO 64055-7308
Mailing address
PO Box 844715
Kansas City, MO 64184-4715
Phone (417) 761-5000
Other practice location 1
4066 Dunnica Ave
Saint Louis, MO 63116-3510
Phone (636) 224-1700
Other providers in Independence, MO
- Djaris Cisneros
- City of Independence
- CJP Surgical LLC
- Marcia Clapp
- Barbara J Clark
- Kyle A Clark
- Laurie Beth Clark
- Madison Rae Clark
- Amelia Gail Clausen
- De'Nesha Clay
All providers in Independence, MO · Psychiatric/Mental Health 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 Jul 30, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.