Individual
CAITLYN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
114 FAIRVIEW AVE, PONCA CITY, OK 74601-2923
(580) 401-0385
Mailing address
114 FAIRVIEW AVE, PONCA CITY, OK 74601-2923
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R96555
OK
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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