Most Relevant Information
Provider Data
| NPI Number: | 1003506361 |
| Provider Name: | MADISON JADE CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/10/2023 |
| Last Updated: | 05/10/2023 |
Provider Practice Location
116 E MAIN ST STE B
WILBURTON
OK
745784230
Practice Location Phone/Fax
| Phone: | 9184072662 |
| Fax: |
Provider Mailing Location
PO BOX 58
RED OAK
OK
745630058
Provider Mailing Phone/Fax
| Phone: | 9184719014 |
| Fax: |