JENNIFER JOANN CLARK (NPI# 1710355615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710355615 |
| Entity Type | Individual |
| Full Name | JENNIFER JOANN CLARK |
| Credential | NP |
| Practice Address |
104 E Main St Anderson MO 64831-4103 |
| Practice Telephone | 4178456984 |
| Practice Fax Number | 4178456976 |
| Mailing Telephone | 4178456984 |
| Mailing Fax Number | 4178456976 |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2019-06-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2015031288 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 201119140A | 05 | |
| MO | 1710355615 | 05 | |
| OK | 200605370A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 327 E Airport Dr, Carthage, MO 648363402 | 4172370604 | 4172370613 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932723038 | Jennifer Michelle Clark | Social Worker | 22 Norva Ave, Frederick, MD 21701-6279 | 2020-06-04 |
| 1982249926 | Jennifer Rae Clark | Nurse Practitioner | 2800 E League City Pkwy Apt 216, League City, TX 77573-1676 | 2019-11-13 |
| 1528546827 | Jennifer Clark | Technician | 59 Forrester St Sw Apt B, Washington, DC 20032-2120 | 2018-07-30 |
| 1265940340 | Jennifer Anne Clark | Counselor | 35 Pulaski Rd, Whitehouse Station, NJ 08889-3516 | 2018-01-11 |
| 1598118572 | Jennifer Clark | Internal Medicine | 1120 W. Michigan Street Gatch Hall Cl 630, Indianapolis, IN 46204 | 2016-07-14 |
| 1295124899 | Jennifer Clark | Behavioral Analyst | 662 Lake George Dr, Melbourne, FL 32940-2221 | 2015-01-20 |
| 1851707194 | Jennifer Sara Clark | Physical Therapist | 797 Evergreen Dr, West Hempstead, NY 11552-3406 | 2014-07-08 |
| 1083988794 | Jennifer Makiki Clark | Health Educator | 5858 Wilshire Blvd Ste 300, Los Angeles, CA 90036-4509 | 2012-02-27 |
| 1639484520 | Jennifer Ann Clark | Speech-Language Pathologist | 5903 Neptune Dr, Fort Collins, CO 80525-3905 | 2010-08-16 |
| 1245567247 | Jennifer Selleck Clark | Nurse Practitioner | 1840 Martin Luther King Jr Blvd Ste C4, Chapel Hill, NC 27514 | 2009-11-11 |
| Street Address |
104 E MAIN ST |
| City | ANDERSON |
| State | MO |
| Zip Code | 64831-4103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700392537 | Angela R Williams | Registered Nurse | 104 E Main St, Anderson, MO 64831-4103 | 2017-12-15 |
| 1063969665 | Sgoh Acquisition, Inc. | Clinic/Center | 104 E Main St, Anderson, MO 64831-4103 | 2016-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447806492 | Ronna Layne Duncan | Occupational Therapist | 734 Industrial Dr, Anderson, MO 64831 | 2019-08-15 |
| 1578961652 | Heidsha L Peterson | Dental Hygienist | 927 N 71 Business Hwy, Anderson, MO 64831 | 2014-12-05 |
| 1851794796 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 224 E Hwy 76, Anderson, MO 64831 | 2014-10-07 |
| 1194141317 | Rebecca A Bender | Nurse Practitioner | 510 Park Street, Anderson, MO 64831 | 2014-03-12 |
| 1205161726 | Kimberly Ann George | Dental Assistant | 508 W. Hwy. 71, Anderson, MO 64831 | 2009-10-16 |
| 1720240500 | Camille Reynaud Hatcher | Dental Hygienist | 508 W 76 Highway, Anderson, MO 64831 | 2008-07-02 |
| 1548469398 | Samantha Jean Sutton | Dentist | 508 W. 76 Hwy, Anderson, MO 64831 | 2007-07-12 |
| 1386774412 | Area Community Health Emissaries, Inc. | Dentist | 508 W 76 Hwy, Anderson, MO 64831 | 2007-03-07 |
| 1336279470 | Avoyn Forga | Dentist | 508 West 76 Hwy., Anderson, MO 64831 | 2007-03-07 |
| 1225142292 | Mustang Drug Inc | Pharmacy | 704 C South Hwy 59, Anderson, MO 64831 | 2006-08-18 |
| Find all providers in zip 64831 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407462773 | Ashley Nicole Jones | Nurse Practitioner | 5226 Fletcher St, Anderson, IN 46013-4819 | 2020-09-21 |
| 1689285538 | Austin Darbyshire | Nurse Practitioner | 215 Fox Trl, Anderson, SC 29621-4417 | 2020-08-13 |
| 1326517194 | Ashlea Bronwen Bates | Nurse Practitioner | 3424 Clemson Blvd., Anderson, SC 29621 | 2018-11-21 |
| 1558871681 | His Solutions Specialty Care Corp. | Nurse Practitioner | 33 W 10th St #621, Anderson, IN 46016-1493 | 2017-10-03 |
| 1760939110 | Crystal Vaughn | Nurse Practitioner | Sac Anmed Health 2000 East Greenville Street, Anderson, SC 29621 | 2016-09-01 |
| 1316318454 | Donna Gibson Marcengill | Nurse Practitioner | 2000 E Greenville St Ste 2000, Anderson, SC 29621-1720 | 2015-10-15 |
| 1750763405 | Holly D. Rogers | Nurse Practitioner | 800 N Fant St., Anderson, SC 29621 | 2015-06-18 |
| 1093019952 | Susan Lee Sanders | Nurse Practitioner | 2017 Norwood Dr, Anderson, IN 46012-1832 | 2011-01-06 |
| 1184931081 | Tracey Glen Schofield Jr. | Nurse Practitioner | 2000 E Greenville St Ste 2800, Anderson, SC 29621-1722 | 2010-09-13 |
| 1073755658 | Jenile J Abell | Nurse Practitioner | 1210 Medical Arts Blvd Ste 206, Anderson, IN 46011-3437 | 2009-03-30 |
| Find all providers in ANDERSON | ||||
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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.