Individual
MADISON JADE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 E MAIN ST STE B, WILBURTON, OK 74578-4230
(918) 407-2662
Mailing address
PO BOX 58, RED OAK, OK 74563-0058
(918) 471-9014
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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