Provider Demographics
NPI:1659261956
Name:CLARK, PATRICE SHEREE
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:SHEREE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 WOODVALE CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4315
Mailing Address - Country:US
Mailing Address - Phone:614-260-4875
Mailing Address - Fax:
Practice Address - Street 1:5424 WOODVALE CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4315
Practice Address - Country:US
Practice Address - Phone:614-260-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant