JESSIE D CLARK (NPI# 1376190298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376190298 |
| Entity Type | Individual |
| Full Name | JESSIE D CLARK |
| Practice Address |
1201 Wesleyan St Fort Worth TX 76105-1536 |
| Mailing Address |
1009 Hidden Lake Dr Burleson TX 76028-6057 |
| Practice Telephone | 8175314444 |
| Mailing Telephone | 8176021468 |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2019-08-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639502214 | Jessie Ann Clark | Occupational Therapist | 4200 Livingstone Pl, Durham, NC 27707-5515 | 2013-08-19 |
| 1952800369 | Jessie Ramona Clark | Speech-Language Pathologist | 600 Pleasant Ave S, Park Rapids, MN 56470 | 2018-02-12 |
| 1437503141 | Jessie F Clark | Specialist/Technologist, Other | 3 Maryland Farms Ste 200, Brentwood, TN 37027-5780 | 2016-04-19 |
| Street Address |
1201 WESLEYAN ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76105-1536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932172913 | Pamela Dean Rast | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2006-02-09 |
| 1164064671 | Sarah Elizabeth Shin | Student in an Organized Health Care Education/Training Program | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-10-16 |
| 1952943474 | Abby Bobo | Student in an Organized Health Care Education/Training Program | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-10-16 |
| 1710538657 | Travis Terranova | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-09-23 |
| 1811545775 | Tuan Anh Bui | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-09-03 |
| 1497303366 | Jarrett Blankenship | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-09-03 |
| 1275181364 | Hayden Brock | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-08-31 |
| 1477100394 | Raquel Velasco Marinelarena | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-08-26 |
| 1194372011 | Brittany M Cardone | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-08-26 |
| 1467009381 | Samantha Manriquez | Specialist/Technologist | 1201 Wesleyan St, Fort Worth, TX 76105-1536 | 2019-08-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477030567 | Brandon Ronald Lee | Optometrist | 2644 E Berry St., Fort Worth, TX 76105 | 2018-07-23 |
| 1366935165 | National Vision, Inc. | Technician/Technologist | 2644 East Berry Street, Fort Worth, TX 76105 | 2018-06-07 |
| 1609363100 | Courtney Mae Gramley | Specialist/Technologist | 1201 Wesleyan St., Fort Worth, TX 76105 | 2018-04-19 |
| 1992213078 | Fresenius Medical Care Se Fort Worth, LLC | Clinic/Center | 3708 E Rosedale St, Fort Worth, TX 76105 | 2018-01-11 |
| 1285978692 | Wal-mart Stores Texas LLC | Technician/Technologist | 2900 Renaissance Square, Fort Worth, TX 76105 | 2012-11-26 |
| 1548584998 | Access Dental of Berry, P.a. | Dentist | 4201 E. Berry Street, Suite #15, Fort Worth, TX 76105 | 2010-03-15 |
| 1811211261 | Access Dental of Rosedale P.a. | Dentist | 3620 E. Rosedale Street, Fort Worth, TX 76105 | 2010-03-15 |
| 1396345799 | Danielle Hampton | Pharmacist | Walmart Pharmacy, 2900 Renaissance Square, Fort Worth, TX 76105 | 2020-10-27 |
| 1174041578 | Destonee Wilson | Physician Assistant | 1650 S Beach St, Fort Worth, TX 76105 | 2017-09-06 |
| 1184019929 | Sheelarani Joseph | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105 | 2015-03-30 |
| Find all providers in zip 76105 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| 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. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922607373 | Benjamin Allen Barrett | Student in an Organized Health Care Education/Training Program | 12244 Langley Hill Dr, Fort Worth, TX 76244-5544 | 2020-10-17 |
| 1538766597 | Billy Derek Huddleston | Student in an Organized Health Care Education/Training Program | 4661 Cool Ridge Ct, Fort Worth, TX 76133-3831 | 2020-10-02 |
| 1942828371 | Ellener Harper | Student in an Organized Health Care Education/Training Program | 9232 Oldwest Trl, Fort Worth, TX 76131-3114 | 2020-07-13 |
| 1396374005 | Mikel Robert Bell | Student in an Organized Health Care Education/Training Program | 855 Montgomery St Ste 257, Fort Worth, TX 76107-2553 | 2020-04-04 |
| 1750919171 | William Thomas Cates | Student in an Organized Health Care Education/Training Program | 3248 W 7th St Apt 308, Fort Worth, TX 76107-2804 | 2020-03-31 |
| 1710514690 | Javier Eduardo Ordonez | Student in an Organized Health Care Education/Training Program | 3512 Princess Victoria Ct, Fort Worth, TX 76137-6074 | 2020-03-23 |
| 1548896749 | Eric Bash | Student in an Organized Health Care Education/Training Program | 6137 Obsidian Creek Dr, Fort Worth, TX 76179-1543 | 2020-03-19 |
| 1700417821 | Abigail U Davis | Student in an Organized Health Care Education/Training Program | 5113 Glen Canyon Rd, Fort Worth, TX 76137-4104 | 2020-01-28 |
| 1699312439 | Lacey Jane Arnett | Student in an Organized Health Care Education/Training Program | 3305 West Cantey St, Fort Worth, TX 76129-0001 | 2019-11-27 |
| 1699322396 | Anastasia Davis | Student in an Organized Health Care Education/Training Program | 3628 Woodmoor Rd, Fort Worth, TX 76133-6336 | 2019-08-19 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.