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

Jack Alan Clark

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1669287801

Jack Alan Clark is a Student in an Organized Health Care Education/Training Program in Tulsa, Oklahoma. Practices as a sole proprietor. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

1111 W 17th St
Tulsa, OK 74107-1886
Phone: (620) 704-6570
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1669287801
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 12, 2025
Last updated in NPPESFebruary 12, 2025
Certification dateFebruary 12, 2025
Mailing address245 S 250th St, Pittsburg, KS 66762-8531

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