Individual
JENNIFER RAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
2800 E LEAGUE CITY PKWY APT 216, LEAGUE CITY, TX 77573-1676
(907) 350-8538
Mailing address
2251 FM 646 RD W STE 155, DICKINSON, TX 77539-3256
(907) 350-8538
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP142270
TX
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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