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Individual

JACOB NICHOLAS CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1140 E MICHIGAN AVE STE 400, LANSING, MI 48912-1806
(517) 364-9650
Mailing address
PO BOX 13008, LANSING, MI 48901-3008

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011462
MI
363A00000X
Physician Assistant
Primary
5601011462APP22
MI

Other

Enumeration date
10/31/2022
Last updated
03/25/2026
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