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JENNIFER LEE CLARK NURSE PRACTITIONER

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1265661045

Individual Registrant:
 JENNIFER LEE CLARK NURSE PRACTITIONER
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1005 BOULDER DR  GRAY, GA 31032 US
Tel: 478-621-2100  Fax: 478-744-0481

Contact information for business:
1005 BOULDER DR  GRAY, GA 31032-6141 US
Tel: 478-621-2100  Fax: 478-744-0481

Registration Information:
NPI: 1265661045
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
GARN173733

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS GA - Page 1



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