Individual
JORDAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 239-3627
Mailing address
BLDG 650 HUEBNER RD, FORY RILEY, KS 66442
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02330
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-02330
KSBHA
KS
Enumeration date
07/03/2019
Last updated
12/02/2025
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