MR. GARY D CLARK CRNA - NPI 1063493468 - Registered Nurse in Bridgeton, MO

Q: What is Gary Clark's NPI number?

The NPI number for Gary Clark is 1063493468. It was assigned to this individual provider in the NPPES registry on November 11, 2005.

Q: What is Gary Clark's specialty?

The primary specialty registered for this NPI is Registered Nurse with taxonomy code 163W00000X.

Q: When was this NPI record last updated?

The NPPES record for Gary Clark was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 24 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

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About Mr. Gary D Clark Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. GARY D CLARK CRNA (NPI 1063493468) is an individual registered nurse in Bridgeton, Missouri, licensed in Missouri (RN057425) and active in the NPI registry since November 2005.

NPPES Registry Identity

NPI1063493468

Entity TypeIndividualMale

Primary Taxonomy163W00000X

Provider Legal NameMR. GARY D CLARKCredential: CRNA

Location Address12303 DEPAUL DRIVEBridgeton, MO 63044

Mailing Address12303 Depaul DriveBridgeton, MO 63044 · (314) 344-7049 · Fax (314) 344-7073

Phone(314) 344-7049

Fax(314) 344-7073

Sole ProprietorNo

Enumeration DateNovember 11, 2005

Last NPPES UpdateJuly 13, 20262 updates tracked since enumeration

✔ NPI 1063493468 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRegistered NurseNursing Service Providers

Taxonomy Code163W00000X

License✔ Licensed in MO · RN057425

Definition

(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.

Also ListedNurse Anesthetist, Certified RegisteredTaxonomy 367500000X · License 057425 (MO)

12303 DEPAUL DRIVE, Bridgeton, MO 63044

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JESSICA WILD FNP

Family Medicine