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General NPI Number Information
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NPI Number | 1821627167
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Entity Type | Individual
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Provider Name | LAUREN D'ANN CLARK NP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 105 S BRYANT AVE STE 101
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City | EDMOND
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State | OK
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Zip | 73034-6330
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Country | US
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Telephone | 405-823-0094
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 RED MAPLE LN
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City | MOORE
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State | OK
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Zip | 73170-1025
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Country | US
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Telephone | 405-823-0094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R0100056
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License Number State | OK
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