Individual
MS. CINDY ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15481 N JARVIS RD, TAHLEQUAH, OK 74464-0233
(918) 456-5131
Mailing address
15481 N JARVIS RD, TAHLEQUAH, OK 74464-0233
(918) 456-5131
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
TS0200X
OK
Other
Enumeration date
06/15/2015
Last updated
06/15/2015
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