Active NPI
Gayle Clark
- Pharmacy Technician
- Tishomingo, OK
National Provider Identifier
1679653570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 6841
- Practice address
- 815 E 6TH Street
Tishomingo, OK 73460 - Phone
- (580) 371-2392
- Fax
- (580) 559-0610
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 6841 | OK | Primary |
Addresses
Primary practice location
815 E 6TH Street
Tishomingo, OK 73460
Mailing address
1001 N Country Club Rd
Ada, OK 74820-2847
Phone (580) 421-4570
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6841 | Other | OK | OK LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6841 | OK | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chickasaw Nation Division of Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Ada, OK
- NPI 1811739071
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184889600000",
"number": "1679653570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 N COUNTRY CLUB RD",
"city": "ADA",
"state": "OK",
"postal_code": "748202847",
"telephone_number": "580-421-4570",
"fax_number": "580-421-6283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 E 6TH STREET",
"city": "TISHOMINGO",
"state": "OK",
"postal_code": "73460",
"telephone_number": "580-371-2392",
"fax_number": "580-559-0610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GAYLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "OK",
"license": "6841",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OK LICENSE",
"identifier": "6841",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tishomingo, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.