Individual
JESSICA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(800) 836-7536
Mailing address
6560 FANNIN ST STE 2100, HOUSTON, TX 77030-2769
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MT222427
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/01/2021
Last updated
03/30/2026
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