Individual
MISS JULIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
307 NORTH BROADWAY, POTEAU, OK 74953-0689
(918) 647-2349
(918) 641-2359
Mailing address
307 NORTH BROADWAY, POTEAU, OK 74953-0689
(918) 647-2349
(918) 641-2359
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363LA2100X
Acute Care Nurse Practitioner
Primary
1528
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200089790A
—
OK
Enumeration date
07/24/2006
Last updated
09/22/2011
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