Individual
JENNIFER P CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
429 N PARK AVE, BRECKENRIDGE, CO 80424
(970) 547-9200
(970) 262-2196
Mailing address
PO BOX 800022, KANSAS CITY, MO 64170-0022
(800) 953-0104
(303) 765-6640
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0003835
CO
363AM0700X
Medical Physician Assistant
Primary
PA.0003835
CO
363AS0400X
Surgical Physician Assistant
PA.0003835
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3583007
—
CO
Enumeration date
10/17/2013
Last updated
03/06/2026
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