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1730631490
JENNIFER JEAN CLARK
PROVO, UT
NPI
1730631490
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: UT 10132491-1206)
Enumeration Date
2016-10-28
Last Update Date
2022-12-03
Business Address
JENNIFER JEAN CLARK PA
1055 N 500 W STE 212
PROVO, UT 84604-3305
Phone number: 801-812-5033
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Mailing Address
JENNIFER JEAN CLARK PA
1055 N 500 W ATTN: CREDENTIALING
PROVO, UT 84604-3305
Phone number: 801-354-8225
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