JACOB CLARK APRN PMHNP-BC NPI 1487009957

NPI Information

NPI: 1487009957
Provider Name: JACOB CLARK, APRN, PMHNP-BC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
138 E 12300 S UNIT 860
DRAPER, UT
ZIP 84020
Phone: (801) 449-1429
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Jacob Clark, APRN, PMHNP-BC is a psychiatric/mental health nurse practitioner in Draper, UT with 2 years of experience. Jacob Clark, APRN, PMHNP-BC NPI is 1487009957. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

138 E 12300 S UNIT 860
DRAPER, UT
ZIP 84020-976
Phone: (801) 449-1429

The NPI 1487009957 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/3/2016 and was last updated on 10/1/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	247200000X	Technician, Other				No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	8480668-4405	UTAH	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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