Individual
JENNIFER JOANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
104 E MAIN ST, ANDERSON, MO 64831-4103
(417) 845-6984
(417) 845-6976
Mailing address
104 E MAIN ST, ANDERSON, MO 64831-4103
(417) 845-6984
(417) 845-6976
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015031288
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710355615
—
MO
05
—
200605370A
—
OK
05
—
201119140A
—
KS
Enumeration date
09/09/2015
Last updated
06/26/2019
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