Individual
DR. NICOLE ANNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
475 W 940 N, PROVO, UT 84604-3301
(801) 357-7930
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 357-7930
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4775416-1205
UT
Other
Enumeration date
08/22/2006
Last updated
01/21/2026
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