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Individual
JENNIFER M. CLARK
Active
Individual
JENNIFER M. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N., FNP, PMHNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
740722
TX
363L00000X
Nurse Practitioner
Primary
NP12069
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193487901
—
TX
01
—
8Y5099
BCBS
TX
01
—
P00622287
RR MEDICARE
TX
Enumeration date
01/18/2008
Last updated
05/08/2025
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