Individual
JESSICA N CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-AG
Contact information
Practice address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 331-6431
(573) 986-5984
Mailing address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 334-6431
(573) 986-5984
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2016011887
MO
363LG0600X
Gerontology Nurse Practitioner
2016011887
MO
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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