Provider Demographics
NPI:1083486724
Name:CLARK, RACHEL MEGAN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MEGAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 ASH ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-2608
Mailing Address - Country:US
Mailing Address - Phone:918-618-7518
Mailing Address - Fax:
Practice Address - Street 1:1425 ASH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2608
Practice Address - Country:US
Practice Address - Phone:918-618-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty