Provider Demographics
NPI:1023352218
Name:CLARK, KAPRIS BENEA (BACHELORS OF SCIENCE)
Entity type:Individual
Prefix:MS
First Name:KAPRIS
Middle Name:BENEA
Last Name:CLARK
Suffix:
Gender:F
Credentials:BACHELORS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 MCKELVEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2550
Mailing Address - Country:US
Mailing Address - Phone:314-206-3900
Mailing Address - Fax:314-206-3992
Practice Address - Street 1:3165 MCKELVEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2550
Practice Address - Country:US
Practice Address - Phone:314-206-3900
Practice Address - Fax:314-206-3992
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker