Provider Demographics
NPI:1285714113
Name:TOERBER-CLARK, JODY S (FNP PMHNP)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:S
Last Name:TOERBER-CLARK
Suffix:
Gender:F
Credentials:FNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 5TH STREET
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547
Mailing Address - Country:US
Mailing Address - Phone:785-456-9773
Mailing Address - Fax:785-456-1432
Practice Address - Street 1:904 5TH STREET
Practice Address - Street 2:PROVIDER ENROLLMENT
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-4619
Practice Address - Country:US
Practice Address - Phone:785-456-9773
Practice Address - Fax:785-456-1432
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45326363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily