Individual
ANGELICA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
227 MEMORIAL DR, GATESVILLE, TX 76528-1028
(254) 248-6500
Mailing address
PO BOX 847408, DALLAS, TX 75284-7408
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05932
TX
Other
Enumeration date
05/15/2012
Last updated
05/15/2012
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