Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Cody Wayne Clark

Individual provider Peer Specialist · NPI 1336968767

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 Ave
Ponca 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 number1336968767
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 3, 2024
Last updated in NPPESOctober 3, 2024
Certification dateOctober 3, 2024
Mailing address620 W Grand Ave, Ponca City, OK 74601-5123

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