Jessica L Clark MD LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

JESSICA L CLARK MD LLC

Practice address

600 Grand Panama Blvd
Panama City Beach, FL 32407-3459

Phone

(233) 767-4850

Fax

(330) 595-4727

NPI assigned

Aug 22, 2022

Last updated

Aug 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Raun D Skyrm

Title

Administrator

Phone

(330) 256-0533

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica Lynn Clark, MD

  • Dermatology Physician
  • Panama City Beach, FL
  • NPI 1740449719
  Medicare reassignment

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1184342578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6605 BUTTON BUCK TRL",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324139577",
            "telephone_number": "330-256-0533",
            "fax_number": "330-595-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GRAND PANAMA BLVD",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324073459",
            "telephone_number": "233-767-4850",
            "fax_number": "330-595-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSICA L CLARK MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-21",
        "status": "A",
        "authorized_official_last_name": "SKYRM",
        "authorized_official_first_name": "RAUN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "330-256-0533"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renese Jackson, PHARMD
• Thomas Albert Jacobson, M.D.
• Timothy Scott Jarrett
• Jessica Jaworski, ARNP, NP-C
• Salena Jerkins, ARNP FNP-C
• Joel G Prather Psy.D, P.a.
• Sharon Lee Johnson, PHD, M.ED, LPC
• Stephen Wesley Johnson, NURSE PRACTITIONER
• Johnsons Family Medicine LLC
• Caitlin Jones, DC

• Dermatology Physician in Panama City Beach, FL
• Providers in Panama City Beach, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.