Individual
JULIANNE ALYSSA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
3315 KETHLEY RD, SHAWNEE, OK 74804-9638
(405) 273-5801
(405) 878-3814
Mailing address
PO BOX 849, SHAWNEE, OK 74802-0849
(405) 273-5801
(405) 878-3814
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
61442
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61442
OK LICENSE
OK
Enumeration date
01/28/2011
Last updated
08/29/2012
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