Clark, Julianne Alyssa

Clark, Julianne Alyssa is an individual health care provider with primary practice located at 3315 Kethley Rd , Shawnee OK 74804-9638. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Clark, Julianne Alyssa can be contacted via phone (405) 273-5801.

Contact Information

Primary practice address
3315 Kethley Rd Shawnee OK 74804-9638
Phone: (405) 273-5801
Fax: (405) 878-3814
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 61442 Oklahoma

Profile Details

NPI number 1417253170
LBN Legal business name Clark, Julianne Alyssa
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 28th, 2011
Last updated Aug 29th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417253170 NPPES
Oklahoma Other 61442 OK LICENSE

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