Provider Demographics
NPI:1073871901
Name:CLARK, PRISCILLA DANIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:DANIELLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:906 W MCDERMOTT DR # 116-371
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:469-541-1601
Mailing Address - Fax:469-541-1612
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1602
Practice Address - Country:US
Practice Address - Phone:469-541-1601
Practice Address - Fax:469-541-1612
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR2310207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology