Clark, Shannon Jackie
Clark, Shannon Jackie is an sole proprietor health care provider with primary practice located at 12729 S Ox Cart Trl , Vail AZ 85641-9232. She recently has only one registered license in Other Service Providers / Contractor, which is considered as her primary health care specialty. Clark, Shannon Jackie can be contacted via phone (512) 214-2841.Contact Information
Primary practice address
12729 S Ox Cart Trl
Vail AZ 85641-9232
Phone: (512) 214-2841
Fax: (520) 750-0056
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Contractor | 171W00000X | 11816 | Arizona |
Profile Details
| NPI number | 1700940855 |
|---|---|
| LBN Legal business name | Clark, Shannon Jackie |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 21st, 2006 |
| Last updated | Dec 26th, 2024 - about 2 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 | 1700940855 | NPPES |
| Arizona | MEDICAID | 162753 |
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