Individual provider · NPI-1

Jennifer Rae Clark, CPNP-PC

Nurse Practitioner, Pediatrics · League City, TX

NPI number1982249926
StatusActive
Last updated in NPPESNov 13, 2019

Details

NPI
1982249926
Entity type
Individual (NPI-1)
Name
Jennifer Rae Clark
Credential
CPNP-PC
Sex
Female
Sole proprietor
No
Enumeration date
Nov 13, 2019
Last updated
Nov 13, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, PediatricsAP142270TXYes

Practice location

2800 E League City Pkwy Apt 216
League City, TX 77573-1676

Phone 907-350-8538

Mailing address

2251 Fm 646 Rd W Ste 155
Dickinson, TX 77539-3256

Phone 907-350-8538

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