JESSE KAY CLARK PA NPI 1043721129

NPI Information

NPI: 1043721129
Provider Name: JESSE KAY CLARK, PA
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
800 5TH AVE STE 300
FORT WORTH, TX
ZIP 76104
Phone: (817) 878-5300
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Jesse Kay Clark, PA is a surgical physician assistant in Fort Worth, TX. Jesse Kay Clark, PA NPI is 1043721129. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

800 5TH AVE STE 300
FORT WORTH, TX
ZIP 76104-303
Phone: (817) 878-5300
Fax: (817) 878-5321

The NPI 1043721129 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 10/17/2017 and was last updated on 9/9/2019.

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	363AS0400X	Physician Assistant	Surgical	PA11698	TEXAS	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: 11/14/2023

NPI Synchronization or Removal

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