| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JENNIFER JEAN CLARK | 1730631490 | 2022-12-03 |
Jennifer Jean Clark [F] graduated in 2016 and primarily specializes in Physician Assistant.
Jennifer Jean Clark is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1730631490. Registration indicates Jennifer Jean Clark is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| PECOS ID | 6305126335 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Jennifer Jean Clark PA |
| Practice Office Address | 1055 N 500 W STE 212 PROVO, UT US |
| Practice Office Telephone | 8018125033 |
| Practice Office Fax | 8018125034 |
| Mailing Address | 1055 N 500 W ATTN: CREDENTIALING PROVO, UT 846043305 US |
| Business Telephone | 8013548225 |
| Business Fax | 8014180941 |
| Direct Messaging Address [CDA/CCD/TXT] | [email protected] | Direct University of Utah |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | 10132491-1206
UT |