Individual
JESSALYNN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1720 NICHOLASVILLE RD, SUITE 506, LEXINGTON, KY 40503-1404
(859) 260-2224
(859) 260-6375
Mailing address
1720 NICHOLASVILLE RD, SUITE 506, LEXINGTON, KY 40503-1404
(859) 260-2224
(859) 260-6375
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3007684
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3007684
STATE LICENSE
KY
Enumeration date
10/26/2012
Last updated
12/02/2020
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