Individual
BRIANNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
709 W OAK, ASHLAND, KS 67831
(620) 635-2241
Mailing address
PO BOX 188, ASHLAND, KS 67831-0188
(620) 635-2241
(620) 635-4481
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05-35880
KS
207Q00000X
Family Medicine Physician
4889
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200294890A
—
OK
Enumeration date
05/22/2009
Last updated
05/20/2014
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