Provider Demographics
NPI:1679945885
Name:ASSI, CLARA B (FNP-BC)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:B
Last Name:ASSI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:B
Other - Last Name:ABOU ASSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-729-0088
Mailing Address - Fax:314-729-3991
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-729-0088
Practice Address - Fax:314-729-3991
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015031879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015031879OtherSTATE LICENSE