Jessica Lynn Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2012027636 Issued in MO

Practice address

1705 Christy Dr
Suite 200
Jefferson City, MO 65101-5195

Phone

(573) 659-5515

Fax

(573) 659-5516

NPI assigned

Dec 3, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Missouri Physical Therapy LLC

  • Physical Therapist
  • Columbia, MO
  • NPI 1558436592
  Medicare reassignment NPD
• Outbound Rehabilitation & Wellness LLC

  • Physical Therapist
  • Jefferson City, MO
  • NPI 1518234681
  Medicare reassignment NPD
• Boone Physician Services, LLC

  • Multi-Specialty Clinic/Center
  • Columbia, MO
  • NPI 1760893259
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354492800000",
    "number": "1063757003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 CHRISTY DR",
            "address_2": "SUITE 200",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015195",
            "telephone_number": "573-659-5515",
            "fax_number": "573-659-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CHRISTY DR",
            "address_2": "SUITE 200",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015195",
            "telephone_number": "573-659-5515",
            "fax_number": "573-659-5516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-03",
        "last_updated": "2012-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2012027636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Christiansen, DDS
• Wesley Carl Christiansen, DDS
• Michele Ernst Christman, LPC, MS
• City of Jefferson
• Annette L Clark, MSW, LCSW
• Mary Elizabeth Clark
• Lucia Clarke, DC
• Claypool Obstetrics and Gynecology LLC
• Casey Claypool, MHS, CF-SLP
• John W Clemens, M.D.

• Physical Therapist in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.