Larissa Pearl Prestado Clavillas, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

228654 Issued in OK

Practice address

1611 Main St
Woodward, OK 73801-3021

Phone

(580) 254-8192

Fax

(580) 254-8687

NPI assigned

Jul 27, 2026

Last updated

Jul 27, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Larissa Pearl Dimaiwat Prestado Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Woodward Health System LLC

  • Anesthesiology Physician
  • Woodward, OK
  • NPI 1306899620
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1785110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1649192212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 26TH ST",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738014122",
            "telephone_number": "580-254-8192",
            "fax_number": "580-254-8687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 MAIN ST",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738013021",
            "telephone_number": "580-254-8192",
            "fax_number": "580-254-8687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAVILLAS",
        "first_name": "LARISSA PEARL",
        "middle_name": "PRESTADO",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-27",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OK",
            "license": "228654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARISSA PEARL",
            "last_name": "PRESTADO",
            "middle_name": "DIMAIWAT",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cimarron Valley Therapeutic Services, Inc.
• Britainee Clark, BSW
• Melinda Sue Clark
• Shanna Marie Clark
• Zelma Clark
• Megan Clem, P.T.
• Ryan T. Clem, P.T.
• Clem's Medical, LLC
• Anna Cole, C-CHW
• Garrett Lee Collier, PHARMD

• Primary Care Nurse Practitioner in Woodward, OK
• Providers in Woodward, OK by specialty
• Primary Care Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.