JENNIFER JUSTINA CLARK (NPI# 1417596016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417596016 |
| Entity Type | Individual |
| Full Name | JENNIFER JUSTINA CLARK |
| Credential | FNP-BC |
| Practice Address |
3710 Sw Us Veterans Hospital Rd Portland OR 97239-2964 |
| Mailing Address |
476 Sw Park St Camas WA 98607-2633 |
| Practice Telephone | 5032208262 |
| Mailing Telephone | 5039987215 |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2019-12-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP61006464 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201908784NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932723038 | Jennifer Michelle Clark | Social Worker | 22 Norva Ave, Frederick, MD 21701-6279 | 2020-06-04 |
| 1982249926 | Jennifer Rae Clark | Nurse Practitioner | 2800 E League City Pkwy Apt 216, League City, TX 77573-1676 | 2019-11-13 |
| 1528546827 | Jennifer Clark | Technician | 59 Forrester St Sw Apt B, Washington, DC 20032-2120 | 2018-07-30 |
| 1265940340 | Jennifer Anne Clark | Counselor | 35 Pulaski Rd, Whitehouse Station, NJ 08889-3516 | 2018-01-11 |
| 1598118572 | Jennifer Clark | Internal Medicine | 1120 W. Michigan Street Gatch Hall Cl 630, Indianapolis, IN 46204 | 2016-07-14 |
| 1295124899 | Jennifer Clark | Behavioral Analyst | 662 Lake George Dr, Melbourne, FL 32940-2221 | 2015-01-20 |
| 1851707194 | Jennifer Sara Clark | Physical Therapist | 797 Evergreen Dr, West Hempstead, NY 11552-3406 | 2014-07-08 |
| 1083988794 | Jennifer Makiki Clark | Health Educator | 5858 Wilshire Blvd Ste 300, Los Angeles, CA 90036-4509 | 2012-02-27 |
| 1639484520 | Jennifer Ann Clark | Speech-Language Pathologist | 5903 Neptune Dr, Fort Collins, CO 80525-3905 | 2010-08-16 |
| 1245567247 | Jennifer Selleck Clark | Nurse Practitioner | 1840 Martin Luther King Jr Blvd Ste C4, Chapel Hill, NC 27514 | 2009-11-11 |
| Street Address |
3710 SW US VETERANS HOSPITAL RD |
| City | PORTLAND |
| State | OR |
| Zip Code | 97239-2964 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780688556 | Richard B Ismach | Emergency Medicine | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2005-06-09 |
| 1285233510 | Leann Waggoner | Social Worker | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2999 | 2020-10-19 |
| 1932708260 | Ashley Kinnaman | Social Worker | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-10-19 |
| 1407453467 | Jonna Bowles | Social Worker | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-10-02 |
| 1255947677 | Audrey Nicole Stuhldreher | Registered Nurse | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-09-21 |
| 1578178513 | Nyssa Karchefski-ross | Registered Nurse | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-09-15 |
| 1952916967 | David Choi | Registered Nurse | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-09-15 |
| 1497360085 | Jason Andrew Wargin | Social Worker | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-09-10 |
| 1760096804 | Mathew Arin Hanson | Registered Nurse | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-09-05 |
| 1619588803 | Julie Kahler | Psychologist | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2020-08-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558979468 | Elise Caitlin Esposito | Student in an Organized Health Care Education/Training Program | 3710 Sw U.S. Veterans Hospital Road, Dental Service P-3 Dent, Attn: Elise Esposito, Portland, OR 97239 | 2020-07-16 |
| 1750908844 | Will Cowan | Student in an Organized Health Care Education/Training Program | 455 Sw Us Veterans Hospital Road., Portland, OR 97239 | 2020-07-06 |
| 1881219657 | Desiree Baer | Licensed Vocational Nurse | Sw Us Veterans Hospital Rd, Portland, OR 97239 | 2020-06-08 |
| 1285266205 | Melissa Irene Wheeler | Registered Nurse | Uhs-8l, 3181 S.w. Sam Jackson Park Road, Portland, OR 97239 | 2020-02-07 |
| 1225687981 | Pheba Mariam Jones | Pharmacist | Ohsu Pharmacy At Chh Building 2, 3303 Sw Bond Ave Rm 1090, Portland, OR 97239 | 2019-09-05 |
| 1801448063 | Alice Huang Huang | Student in an Organized Health Care Education/Training Program | 3710 Sw Veterans Road, Portland, OR 97239 | 2019-07-09 |
| 1710446273 | Ellen Noreen Kessi | Social Worker | 3710 Sw Us Veterans Rd., Portland, OR 97239 | 2019-03-14 |
| 1508335704 | Jacqueline Marie Mular | Marriage & Family Therapist | 5550 Sw Macadam Suite 100, Portland, OR 97239 | 2018-11-16 |
| 1275030926 | Carly Elizabeth Dougher | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd., Portland, OR 97239 | 2018-04-10 |
| 1780188094 | Dennis John Samuel | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd. L-579, Portland, OR 97239 | 2018-03-21 |
| Find all providers in zip 97239 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043822794 | Danielle Langer | Nurse Practitioner | 35 Ridgeview Rd, Portland, CT 06480-4014 | 2020-08-23 |
| 1508476250 | Harrington Health Clinic | Nurse Practitioner | 310 Nw Glisan Street, Portland, OR 97209 | 2020-08-07 |
| 1114566650 | Sadie Garnache-poirier | Nurse Practitioner | 65 W Commercial St Ste 107, Portland, ME 04101-4789 | 2020-01-02 |
| 1902441629 | Jennifer Marie Colpitts | Nurse Practitioner | 1600 Congress St Ste B, Portland, ME 04102-2148 | 2019-11-18 |
| 1477102689 | Raquel A Bishop | Nurse Practitioner | 12400 Nw Cornell Rd Ste 100, Portland, OR 97229 | 2019-09-10 |
| 1265081640 | Christina Lee | Nurse Practitioner | 144 State St # 1, Portland, ME 04101-3776 | 2019-09-09 |
| 1407401474 | Abby Christine Vopal | Nurse Practitioner | 66 Bramhall St Fl 1, Portland, ME 04102-3355 | 2019-08-07 |
| 1770145294 | Cynthia Marie Martinez | Nurse Practitioner | 1145 Austin St, Portland, TX 78374-2013 | 2019-07-04 |
| 1528532306 | Matthew James Keelin | Nurse Practitioner | 6801 Ne Cornfoot Rd, Portland, OR 97218-2743 | 2019-01-15 |
| 1659847580 | Colleen Jeanette Scott | Nurse Practitioner | 650 Nw Irving St, Portland, OR 97209-1272 | 2018-10-18 |
| Find all providers in PORTLAND | ||||
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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.