# VANESSA CHRISTINA CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1932681764
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 085.006689 | IL | Yes |
| 363A00000X | Physician Assistant | 61100713 | WA | — |

## Other

- **Enumeration date:** 08/29/2018
- **Last updated:** 01/12/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 085.006689 | PHYSICIAN ASSISTANT LICENSE | IL |
| 01 | — | 1151434 | NCCPA | — |
| 01 | — | 61100713 | PHYSICIAN ASSISTANT LICENSE | WA |