NPI 1730170796

Gregory P Clark, PA

Practitioner Physician Assistant Powell, WY

Practice location

Address: 777 Avenue H Powell Valley Healthcare INC, Powell, WY 82435
Phone: (307) 754-3405
Fax: (307) 754-1207
Mailing address: 777 Avenue H, Powell, WY 82435

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 203 (WY)

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Registry record

NPI: 1730170796
Entity type: Individual
Sex (as registered): Male
NPI issued: 31 Oct 2005
Record last updated: 13 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.