Individual
JENNIFER JEAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1055 N 500 W STE 212, PROVO, UT 84604-3305
(801) 812-5033
(801) 812-5034
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10132491-1206
UT
Other
Enumeration date
10/28/2016
Last updated
12/03/2022
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