Provider Demographics
NPI:1568198604
Name:CLARK, SARAH ELIZABETH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-1324
Mailing Address - Country:US
Mailing Address - Phone:817-714-9997
Mailing Address - Fax:817-280-9962
Practice Address - Street 1:1726 CHADWICK CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3318
Practice Address - Country:US
Practice Address - Phone:817-510-6662
Practice Address - Fax:817-280-9962
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99490176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty