Individual provider Active NPI

Jessica Autumn Clark

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Huntsville, AL
National Provider Identifier
1104560317
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
License
4187 Issued in AL
Practice address
101 Sivley Rd SW
Huntsville, AL 35801-4470
Phone
(256) 265-1000
NPI assigned
Apr 24, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4187 AL
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 4187 AL Primary
Student in an Organized Health Care Education/Training Program 390200000X MS

Addresses

Primary practice location

101 Sivley Rd SW
Huntsville, AL 35801-4470

Mailing address

101 Sivley Rd SW
Huntsville, AL 35801-4470
Phone (256) 265-1000

Other practice location 1

860 S Madison St
Tupelo, MS 38801-4905
Phone (615) 513-4978

Other practice location 2

1802 6th Ave S
Birmingham, AL 35233-1932
Phone (205) 934-2411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220726003836 MS Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 3971985706

Care Compare profile

Medicare Care Compare
Specialty
Hospice/Palliative Care
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Suite 21007
Huntsville, AL 35813

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4187ALMDHospice and Palliative Medicine (Internal Medicine) Physician

NPI Registry JSON

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

{
    "created_epoch": "1650758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1104560317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SIVLEY RD SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014470",
            "telephone_number": "256-265-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SIVLEY RD SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014470",
            "telephone_number": "256-265-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "860 S Madison St",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388014905",
            "country_code": "US",
            "telephone_number": "615-513-4978",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1802 6th Ave S",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352331932",
            "country_code": "US",
            "telephone_number": "205-934-2411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JESSICA",
        "middle_name": "AUTUMN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-24",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "4187",
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "AL",
            "license": "4187",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MS",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.