Individual
JENATTE VIRGINIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4209 TIETON DR STE 102, YAKIMA, WA 98908-3377
(509) 654-9810
(509) 966-8812
Mailing address
4209 TIETON DR STE 102, YAKIMA, WA 98908-3377
(509) 654-9810
(509) 966-8812
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
AP60329890
WA
363LF0000X
Family Nurse Practitioner
AP 60329890
WA
Other
Enumeration date
04/24/2013
Last updated
11/10/2021
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