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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

BRENNA CLARK
NPI 1457053274
Student in an Organized Health Care Education/Training Program in Saint Louis, MO

Active since March 17, 2023PECOS Enrolled
1201 S GRAND BLVD, SAINT LOUIS, MO 63104(314) 257-8000(314) 977-1664 Get Directions Write a Review

NPPES record last updated: July 31, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 31, 2026, Mar 17, 2023 (2 updates tracked since 2023).

About Brenna Clark NPPES

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

BRENNA CLARK (NPI 1457053274) is an individual student in an organized health care education/training program in Saint Louis, Missouri and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457053274
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameBRENNA CLARK
Location Address1201 S GRAND BLVDSaint Louis, MO 63104-1016
Mailing Address1008 S Spring AveSaint Louis, MO 63110-2520 · (314) 977-2605 · Fax (314) 977-1664
Phone(314) 257-8000
Fax(314) 977-1664
Sole ProprietorNo
Enumeration DateMarch 17, 2023
Last NPPES UpdateJuly 31, 20262 updates tracked since enumeration
NPPES CertifiedJuly 31, 2026
✔ NPI 1457053274 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1201 S GRAND BLVD, Saint Louis, MO 63104
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brenna Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

DOUG LONGO APRN
Nurse Practitioner (Acute Care)
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 257-8000
JOHN JOSEPH HOUSER
Student in an Organized Health Care Education/Training Program
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 257-8000
NABIHA NOOR SHAMSHUDDIN MD
Hospitalist
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 257-8000
AMAN PATEL
Student in an Organized Health Care Education/Training Program
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 257-8000
MS. KEELEY FERRELL RYAN PA-C
Physician Assistant
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 257-1320
PATRICK SWEENEY
Student in an Organized Health Care Education/Training Program
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 257-8000
DR. SHAMEELA NASRULLAH KHIMANI MD
Pediatrics
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 617-3239
IBRAHIM SHAMASNEH M.D.
Hospitalist
1201 S GRAND BLVD
SAINT LOUIS, MO 63104
St. Louis City (314) 617-2000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brenna Clark's NPI number?

The NPI number for Brenna Clark is 1457053274. It was assigned to this individual provider in the NPPES registry on March 17, 2023.

Where is Brenna Clark located?

Brenna Clark practices at 1201 S Grand Blvd, Saint Louis, MO 63104. The listed phone number is (314) 257-8000.

What is Brenna Clark's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Brenna Clark enrolled in Medicare?

Yes. Brenna Clark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Brenna Clark was last updated on July 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.