Individual
DESIREE DEON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9600 S 1300 E STE 240, SANDY, UT 84094-3783
(801) 965-3600
Mailing address
7181 S CAMPUS VIEW DR, WEST JORDAN, UT 84084-4312
(801) 965-3505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9507169-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9507169-1206
STATE LICENSE
UT
Enumeration date
10/08/2019
Last updated
10/08/2019
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