ANDREA CLARK RD LD NPI 1063863959

NPI Information

  • NPI: 1063863959
  • Provider Name: ANDREA CLARK, RD, LD
  • Classification: Dietitian, Registered - 133VN1004X
  • Specialization: Nutrition, Pediatric
  • Entity Type: Individual
  • Address: 1 CHILDRENS PL
    FOOD AND NUTRITION LS-15
    SAINT LOUIS, MO
    ZIP 63110
  • Phone: (314) 454-2648

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NPI Details

Andrea Clark, RD, LD is a nutrition and pediatric dietitian registered in Saint Louis, MO. The provider is an individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition therapy for pediatric patients. Specialists work directly with healthy and/or ill children (newborn up to 21 years of age) as well as children with special health care needs in a variety of settings (hospitals, community-based and/or family-centered programs, education programs, home, etc.), OR indirectly through management, care coordination, education, quality improvement, or research practice linked specifically to pediatric nutrition. Andrea Clark, RD, LD NPI is 1063863959. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1 CHILDRENS PL
FOOD AND NUTRITION LS-15
SAINT LOUIS, MO
ZIP 63110-002
Phone: (314) 454-2648
Fax: (314) 454-2557

The enumeration date for this NPI number is 6/22/2016 and was last updated on 6/22/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1133VN1004XDietitian, RegisteredNutrition, Pediatric133VN1004XMISSOURIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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