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JACK ALAN CLARK
NPI 1669287801
Student in an Organized Health Care Education/Training Program in Tulsa, OK

Active since February 12, 2025
1111 W 17TH ST, TULSA, OK 74107(620) 704-6570 Get Directions Write a Review

NPPES record last updated: February 12, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jack Alan Clark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK ALAN CLARK (NPI 1669287801) is an individual student in an organized health care education/training program in Tulsa, Oklahoma and active in the NPI registry since February 2025.

NPPES Registry Identity

NPI1669287801
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACK ALAN CLARK
Location Address1111 W 17TH STTulsa, OK 74107-1886
Mailing Address245 S 250th StPittsburg, KS 66762-8531 · (620) 704-6570
Phone(620) 704-6570
Sole ProprietorYes
Enumeration DateFebruary 12, 2025
NPPES CertifiedFebruary 12, 2025
✔ NPI 1669287801 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1111 W 17TH ST, Tulsa, OK 74107
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GRAHAM NATHAN JAMEISON MAT, ATC
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 237-2828
MARIYA BOBEN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
KARLYN TANZEY
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
KAYLEY ANTHAMATTEN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
CHASE YAGER
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (405) 613-1540
MACKENZIE LYNN HATTABAUGH
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
ASHLEE EASTMAN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 805-1752
DAVID ROBERT WAXMAN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Clark's NPI number?

The NPI number for Jack Clark is 1669287801. It was assigned to this individual provider in the NPPES registry on February 12, 2025.

Where is Jack Clark located?

Jack Clark practices at 1111 W 17th St, Tulsa, OK 74107. The listed phone number is (620) 704-6570.

What is Jack Clark's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Jack Clark was last updated on February 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.