Cody Wayne Clark
Cody Wayne Clark is a Peer Specialist in Ponca City, Oklahoma. Practices as a sole proprietor. Registered with an NPI since 2024.
- In the registry since
- 2024
Practice location Address checks out
620 W Grand AvePonca City, OK 74601-5123
Phone: (580) 762-1462
Fax: (581) 765-7299
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Peer Specialist (primary) | Taxonomy 175T00000X |
|---|
Record details
| NPI number | 1336968767 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | October 3, 2024 |
| Last updated in NPPES | October 3, 2024 |
| Certification date | October 3, 2024 |
| Mailing address | 620 W Grand Ave, Ponca City, OK 74601-5123 |
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Shanell Dent
620 W Grand Ave, Ponca City, OK 74601-5123 · (580) 762-1462