Individual
JESSE N CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
10122 E. 10TH STREET, SUITE 100, INDIANAPOLIS, IN 46229-2697
(317) 355-5717
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004005A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201084130
—
IN
01
—
P01424293
RR MEDICARE
IN
Enumeration date
06/21/2010
Last updated
06/09/2021
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