JENNA ELIZABETH CLARK (NPI# 1104201649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104201649 |
| Entity Type | Individual |
| Full Name | JENNA ELIZABETH CLARK |
| Credential | NP |
| Practice Address |
969 Lakeland Dr Jackson MS 39216-4606 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6012004644 |
| Practice Fax Number | 6012004645 |
| Mailing Telephone | 6012004749 |
| Mailing Fax Number | 6012005929 |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2015-07-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R890237 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144687492 | Jenna Marie Clark | Registered Nurse | 7611 Peterson Rd, Conover, OH 45317-9721 | 2016-01-18 |
| 1093123507 | Jenna Clark | Pharmacist | 1700 Wheeling St, Aurora, CO 80045-7211 | 2014-07-28 |
| 1265757736 | Jenna M Clark | Social Worker | 1445 N 4th St, New Richmond, WI 54017-1063 | 2010-03-29 |
| Street Address |
969 LAKELAND DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306843131 | Joseph N Candelora | Pathology | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2005-07-07 |
| 1316554736 | Brooke Collins | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-09-29 | |
| 1972117232 | William Paul Coe | Nurse Practitioner | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-09-03 |
| 1376157099 | Kathryn Taylor Parvin | Radiology | 969 Lakeland Dr, Jackson, MS 39216-4699 | 2020-09-01 |
| 1235741646 | Stephanie H Atkins | Student in an Organized Health Care Education/Training Program | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-08-18 |
| 1063038636 | Ayanna Washington | Registered Nurse | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-06-19 |
| 1669092227 | Christopher L Stephens | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-04-23 |
| 1578190385 | Lindsey Elizabeth Jibol | Counselor | 969 Lakeland Dr, Jackson, MS 39216-4699 | 2020-03-24 |
| 1801436951 | Callie Bridges | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-01-07 |
| 1053951194 | Zachary Halliwell | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-01-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113627 | Jessicah Blasdel | Nurse Practitioner | 113 W Michigan Ave, Jackson, MI 49201-1340 | 2020-10-31 |
| 1801406335 | Jade Russell | Nurse Practitioner | 2205 W Morrell St, Jackson, MI 49203-1357 | 2020-08-10 |
| 1992315212 | Patrecia Campbell | Nurse Practitioner | 2570 Bailey Ave Ste 7, Jackson, MS 39213-6905 | 2020-08-01 |
| 1669008926 | Kristine Edwards | Nurse Practitioner | 723 Woodlawn Ave, Jackson, MI 49203-2921 | 2020-03-19 |
| 1295366391 | Christy White | Nurse Practitioner | 363 Old Pinson Rd, Jackson, TN 38301-9576 | 2020-01-28 |
| 1972141620 | Primary Care - Bemis, LLC | Nurse Practitioner | 1385 S Highland Ave Ste B4, Jackson, TN 38301-7547 | 2019-12-12 |
| 1174164263 | Tami Anne Miller | Nurse Practitioner | 124 N Bast St, Jackson, MO 63755-1704 | 2019-10-01 |
| 1265080584 | Cameron Nicole Howard | Nurse Practitioner | 1860 Chadwick Dr Ste 256, Jackson, MS 39204-3486 | 2019-08-29 |
| 1831750843 | Rhiannon Michelle Andresen | Nurse Practitioner | 1022 Greystone Sq, Jackson, TN 38305-3580 | 2019-06-21 |
| 1902376361 | Jenay B Krumm | Nurse Practitioner | 1201 E Michigan Ave Ste 200, Jackson, MI 49201-1855 | 2018-11-28 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.