Provider Demographics
NPI:1265423461
Name:CLUBINE, KARLA DENISE (FNP/PNP)
Entity type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:DENISE
Last Name:CLUBINE
Suffix:
Gender:F
Credentials:FNP/PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22320 HIGHWAY M
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MO
Mailing Address - Zip Code:65236-2205
Mailing Address - Country:US
Mailing Address - Phone:660-272-3332
Mailing Address - Fax:
Practice Address - Street 1:130 E LOCKLING ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2337
Practice Address - Country:US
Practice Address - Phone:660-258-1050
Practice Address - Fax:660-258-1052
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425996808Medicaid
MO000081365Medicare ID - Type Unspecified
MO425996808Medicaid