Individual
JARED DALE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
4077 JEFFERSON AVE, TEXARKANA, AR 71854-1509
(870) 330-9200
Mailing address
PO BOX 1326, MARSHALL, TX 75671-1326
(903) 927-3782
(903) 927-1764
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
215134
AR
363LG0600X
Gerontology Nurse Practitioner
AP141588
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP141588
APN LICENSE
TX
Enumeration date
06/06/2019
Last updated
09/19/2025
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