JENNIFER JOANN CLARK NP NPI 1710355615

NPI Information

  • NPI: 1710355615
  • Provider Name: JENNIFER JOANN CLARK, NP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 104 E MAIN ST
    ANDERSON, MO
    ZIP 64831
  • Phone: (417) 845-6984

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NPI Details

Jennifer Joann Clark, NP is a family nurse practitioner in Anderson, MO. Jennifer Joann Clark, NP NPI is 1710355615. 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:

104 E MAIN ST
ANDERSON, MO
ZIP 64831-103
Phone: (417) 845-6984
Fax: (417) 845-6976

The NPI 1710355615 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 9/9/2015 and was last updated on 6/26/2019.

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
1363LF0000XNurse PractitionerFamily2015031288MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1201119140AMEDICAIDKANSAS
21710355615MEDICAIDMISSOURI
3200605370AMEDICAIDOKLAHOMA

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: 11/21/2025

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