JENNIFER S. CLARK (NPI# 1891721601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891721601 |
| Entity Type | Individual |
| Full Name | JENNIFER S. CLARK |
| Other Name | JENNIFER S RAUE |
| Credential | PA-C |
| Practice Address |
500 Wind Ridge Dr. Wausau WI 54401-4173 |
| Practice Telephone | 7158472611 |
| Mailing Telephone | 7158472611 |
| Mailing Fax Number | 7158472612 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2010-12-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1648 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | WI STATE LICENSE | 1648-023 | 01 |
| 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 |
500 WIND RIDGE DR. |
| City | WAUSAU |
| State | WI |
| Zip Code | 54401-4173 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043215692 | Samer Jabbour | Internal Medicine | 500 Wind Ridge Dr., Wausau, WI 54401-4173 | 2005-06-20 |
| 1750547378 | Andrew Mykytsey | Internal Medicine | 500 Wind Ridge Dr., Wausau, WI 54401-4173 | 2008-08-03 |
| 1134130594 | Michael A Haase | Internal Medicine | 500 Wind Ridge Dr., Wausau, WI 54401-4173 | 2006-08-11 |
| 1497734750 | Kevin E Rist | Internal Medicine | 500 Wind Ridge Dr., Wausau, WI 54401-4173 | 2006-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164031464 | Central Wisconsin Endodontic Specialists LLC | Dentist | 2606 Stewart Avenue, #102, Wausau, WI 54401 | 2020-07-23 |
| 1376161976 | Family Foot and Ankle Clinic LLC | Podiatrist | 1901 Westwood Boulevard, Wausau, WI 54401 | 2020-07-09 |
| 1336701895 | Amy Kluetz | Counselor | 3000 Westhill Drive, Suite 100, Wausau, WI 54401 | 2019-07-05 |
| 1437640877 | Joseph T Fitz | Student in an Organized Health Care Education/Training Program | Aspirus Wausau Family Medicine, 425 Wind Ridge Drive, Wausau, WI 54401 | 2018-05-22 |
| 1699293241 | Amanda Nedd | Dietitian, Registered | 425 Pine Ridge Boulevard Suite 220 C, Wausau, WI 54401 | 2017-09-05 |
| 1396287447 | Dee Cha | Nurse Anesthetist, Certified Registered | 4851 Rachel Ln Apt 5, Wausau, WI 54401 | 2016-11-07 |
| 1013389618 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 2727 Plaza Dr., Wausau, WI 54401 | 2015-10-22 |
| 1881091163 | Judy Lao | Dental Hygienist | 413 North 17th Avenue, Wausau, WI 54401 | 2014-12-02 |
| 1295012011 | Allison Waraksa | Pharmacist | 504 S. 17th Ave, Wausau, WI 54401 | 2011-11-08 |
| 1881974053 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 504 S 17th Ave, Wausau, WI 54401 | 2011-08-19 |
| Find all providers in zip 54401 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053803239 | Hayley Marie Schanen | Physician Assistant | 2200 Westwood Dr, Wausau, WI 54401-7806 | 2018-06-04 |
| 1164959565 | Laura Berry | Physician Assistant | 2720 Plaza Dr Ste 1100, Wausau, WI 54401-4169 | 2017-05-16 |
| 1023494085 | Katrina Marie Mattek | Physician Assistant | 227500 Rib Mountain Dr Ste 200, Wausau, WI 54401-5052 | 2015-07-31 |
| 1467705327 | Tyler P Laber | Physician Assistant | 2800 Westhill Dr Ste 200, Wausau, WI 54401-3770 | 2012-10-17 |
| 1831290667 | Krista Botsford | Physician Assistant | 9004 Hollirob Ln, Wausau, WI 54403-9171 | 2006-09-26 |
| 1720044340 | Aaron C Wanish | Physician Assistant | 225000 Hummingbird Rd Ste 100, Wausau, WI 54401-2950 | 2006-04-22 |
| 1114989050 | Jody L Wilkins | Physician Assistant | 3000 Westhill Dr, Suite 100, Wausau, WI 54401-3795 | 2006-04-05 |
| 1578533949 | Kristin Ruesch | Physician Assistant | 3300 Westhill Dr, Wausau, WI 54401-4710 | 2006-01-26 |
| 1548248727 | Carla J Heiden | Physician Assistant | 500 Wind Ridge Drive, Cardiovascular Associates, Wausau, WI 54401 | 2006-01-06 |
| 1861027559 | Amber Jeanne Brock | Physician Assistant | 3300 Westhill Dr, Wausau, WI 54401-4710 | 2020-03-03 |
| Find all providers in WAUSAU | ||||
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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.