| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JACOB CLARK | 1487009957 | 2022-10-01 |
Jacob Clark is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1487009957. Registration indicates Jacob Clark is a provider of services with a specialization in Technologists, Technicians & Other Technical Service Providers, Technician, Other (Technician, Other, ) (Technician, Other, Technologists, Technicians & Other Technical Service Providers) Access to Mental Health/Behavioral Health Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Psych/Mental Health, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Psych/Mental Health, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Entity Type | Individual |
| Provider Name | Jacob Clark APRN, PMHNP-BC |
| Practice Office Address | 138 E 12300 S UNIT 860 DRAPER, UT US |
| Practice Office Telephone | 8014491429 |
| Mailing Address | 138 E 12300 S UNIT 860 DRAPER, UT 840207976 US |
| CONNECT URL [] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 247200000X | Technologists, Technicians & Other Technical Service Providers Technician, Other Technician, Other Technician, Other Technologists, Technicians & Other Technical Service Providers | |
| 363LP0808X PRIMARY | Access to Mental Health/Behavioral Health Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Psych/Mental Health All Other Specialties & Provider Types Nurse Practitioner Psych/Mental Health Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 8480668-4405
UT |