Individual
JODY A. STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
932 W IDAHO AVE, SUITE 100, ONTARIO, OR 97914-2155
(541) 889-2244
(541) 889-2626
Mailing address
PO BOX J, ONTARIO, OR 97914-0020
(541) 889-2244
(541) 889-2626
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
079043254N1
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
200550081NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500614019
—
OR
05
—
500656154
—
OR
Enumeration date
10/17/2006
Last updated
10/19/2022
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