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General NPI Number Information
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NPI Number | 1881403327
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Entity Type | Individual
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Provider Name | NATASHA K CLARK
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 231 E GRAHAM AVE
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City | PRYOR
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State | OK
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Zip | 74361-2436
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Country | US
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Telephone | 918-825-1405
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Fax |
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Provider Business Mailing Address
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Address Line | 7015 E 618 RD
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City | PEGGS
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State | OK
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Zip | 74452-2079
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Country | US
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Telephone | 918-882-2684
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 37V136193062
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License Number State | OK
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