Individual
MRS. JENNIFER GAYLE RIES-CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNPC
Contact information
Practice address
8009 W SALTER DR, PEORIA, AZ 85382-4440
(602) 663-8127
Mailing address
8009 W SALTER DR, PEORIA, AZ 85382-4440
(602) 663-8127
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
219824
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219824
ARIZONA ADVANCED PRACTICE LICENCE
AZ
01
—
RN157294
ARIZONA STATE BOARD OF NURSING
AZ
Enumeration date
03/12/2019
Last updated
03/12/2019
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