Jennifer L.K. Clark, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

R4N27 Issued in MO

Practice address

1 S Keene St
Columbia, MO 65201-7199

Phone

(573) 443-2402

Fax

(573) 443-0574

NPI assigned

Aug 30, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326844800000",
    "number": "1184617771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S KEENE ST",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652017199",
            "telephone_number": "573-443-2402",
            "fax_number": "573-443-0574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S KEENE ST",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652017199",
            "telephone_number": "573-443-2402",
            "fax_number": "573-443-0574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "L.K.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2012-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "R4N27",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206669004",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Cecilia Clark, CCC-SLP
• Clayton Charles Clark, FNP
• Frank I Clark, MD
• Henry William Clark, M.A., LPC
• Jason M Clark, O.D.
• Jennifer Nicole Clark, CRNA
• Megan Elizabeth Clark, M.D.
• Adam Clarke
• Christine Clarke
• Richard E. Clarke, HIS

• Physical Medicine & Rehabilitation Physician in Columbia, MO
• Providers in Columbia, MO by specialty
• Physical Medicine & Rehabilitation Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.