Healthcare Provider Details

I. General information

NPI: 1407165293
Provider Name (Legal Business Name): CLARK K SESSIONS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 300 N
ROOSEVELT UT
84066-2336
US

IV. Provider business mailing address

RR 1 BOX 1200
ROOSEVELT UT
84066-9716
US

V. Phone/Fax

Practice location:
  • Phone: 435-722-4691
  • Fax:
Mailing address:
  • Phone: 435-760-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7790589-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: