Clark, Desiree Deon
Clark, Desiree Deon is an individual health care provider with primary practice located at 9600 S 1300 E Ste 240 , Sandy UT 84094-3783. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Clark, Desiree Deon can be contacted via phone (801) 965-3600.Contact Information
Primary practice address
9600 S 1300 E Ste 240
Sandy UT 84094-3783
Phone: (801) 965-3600
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 9507169-1206 | Utah |
Profile Details
| NPI number | 1144861451 |
|---|---|
| LBN Legal business name | Clark, Desiree Deon |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 8th, 2019 |
| Last updated | Oct 8th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144861451 | NPPES |
| Utah | Other | 9507169-1206 | STATE LICENSE |
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