Individual
JAINIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP-C
Contact information
Practice address
8111 S EMERSON AVE STE 101, INDIANAPOLIS, IN 46237-8601
(317) 528-1420
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28171363A
IN
363LF0000X
Family Nurse Practitioner
Primary
71011866A
IN
Other
Enumeration date
10/13/2021
Last updated
01/09/2023
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