Healthcare Provider Details

I. General information

NPI: 1508772005
Provider Name (Legal Business Name): ASHLEE CLARK PRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6128 E 38TH ST
TULSA OK
74135-5832
US

IV. Provider business mailing address

8909 N 148TH EAST AVE
OWASSO OK
74055-8507
US

V. Phone/Fax

Practice location:
  • Phone: 539-242-3322
  • Fax:
Mailing address:
  • Phone: 539-242-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: