Active NPI
Lanyn Clark
- Adult Health Nurse Practitioner
- Saint Louis, MO
National Provider Identifier
1992167522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 2015014622
- Practice address
- 40 Ladue Ter
Saint Louis, MO 63124-2048 - Phone
- (314) 954-9958
- NPI assigned
- Mar 23, 2016
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 2015014622 | MO | Primary |
Addresses
Primary practice location
40 Ladue Ter
Saint Louis, MO 63124-2048
Mailing address
40 Ladue Ter
Saint Louis, MO 63124-2048
Phone (314) 954-9958
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015014622 | MO | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458691200000",
"number": "1992167522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 LADUE TER",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631242048",
"telephone_number": "314-954-9958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 LADUE TER",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631242048",
"telephone_number": "314-954-9958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LANYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-23",
"last_updated": "2016-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MO",
"license": "2015014622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; 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.