| NPI | 1043215601 |
|---|---|
| Former Name | JENNIFER RACHEL CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 45306) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 149378) |
| 363L00000X Nurse Practitioner (Licence: OK 97914) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2022-01-27 |