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DESIRAE CLARK
NPI 1477100717
Prosthetic/Orthotic Supplier in Kansas City, MO

Active since August 21, 2019
5100 LYDIA AVE, KANSAS CITY, MO 64110(826) 749-9147 Get Directions Write a Review

NPPES record last updated: August 21, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Desirae Clark NPPES

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

DESIRAE CLARK (NPI 1477100717) is an individual prosthetic/orthotic supplier provider in Kansas City, Missouri and active in the NPI registry since August 2019.

NPPES Registry Identity

NPI1477100717
Entity TypeIndividualFemale
Primary Taxonomy335E00000X
Provider Legal NameDESIRAE CLARK
Location Address5100 LYDIA AVEKansas City, MO 64110-2608
Mailing AddressPo Box 300564Kansas City, MO 64130-0564 · (816) 749-9147
Phone(826) 749-9147
Sole ProprietorYes
Enumeration DateAugust 21, 2019
✔ NPI 1477100717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyProsthetic/Orthotic SupplierSuppliers
Taxonomy Code335E00000X
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
5100 LYDIA AVE, Kansas City, MO 64110
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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 Desirae Clark's NPI number?

The NPI number for Desirae Clark is 1477100717. It was assigned to this individual provider in the NPPES registry on August 21, 2019.

Where is Desirae Clark located?

Desirae Clark practices at 5100 Lydia Ave, Kansas City, MO 64110. The listed phone number is (826) 749-9147.

What is Desirae Clark's specialty?

The primary specialty registered for this NPI is Prosthetic/Orthotic Supplier with taxonomy code 335E00000X.

When was this NPI record last updated?

The NPPES record for Desirae Clark was last updated on August 21, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years 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.