Individual
SHELBY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 W I 44 SERVICE RD, OKLAHOMA CITY, OK 73112-8713
(405) 336-1665
Mailing address
6913 EAGLES LNDG, OKLAHOMA CITY, OK 73135-1916
(405) 887-8384
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-1287880
PRIVATE DUTY HOME CARE
OK
Enumeration date
07/11/2022
Last updated
07/16/2022
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