Jenatte Clark Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

JENATTE CLARK DERMATOLOGY PLLC

Practice address

4209 Tieton Dr Ste 102
Yakima, WA 98908-3377

Phone

(509) 945-7777

Fax

(509) 966-8812

NPI assigned

Jul 19, 2021

Organization subpart

No

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

Authorized official

Name

Jenatte Clark, ARNPNPI 1003250663

Title

Family Nurse Practitioner

Phone

(509) 945-7777

Specialties & licenses 1

Addresses

Other names 1

• Jenatte Clark Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jenatte Virginia Clark, ARNP

  • Dermatology Physician
  • Yakima, WA
  • NPI 1003250663

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Shannon Eloise Bolt, ARNP

  • Family Nurse Practitioner
  • Yakima, WA
  • NPI 1083006522
  Medicare reassignment Care Compare group NPD
• Caroline Clark, ARNP

  • Family Nurse Practitioner
  • Yakima, WA
  • NPI 1861586182
  Medicare reassignment NPD

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

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626652800000",
    "number": "1225601164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4209 TIETON DR STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083377",
            "telephone_number": "509-945-7777",
            "fax_number": "509-966-8812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4209 TIETON DR STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083377",
            "telephone_number": "509-945-7777",
            "fax_number": "509-966-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENATTE CLARK DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JENATTE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "509-945-7777",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jenatte Clark Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Raven Java-McCandless
• Amanda Marie Jean
• Jeanette M. Stromme O.D. PLLC
• Jeffrey D Pruiett DMD
• Jeffreystrammelldds,Christopherptrammelldds,Timothyggutmanndds,Rossdau
• Debra L Jenkins, M.A., CCC-A
• Mary Jenkins, PA
• Jennifer L Gindt Arnp-C
• Geri Lee Jennings, RD
• Ron Jennings, RPH

• Dermatology Physician in Yakima, WA
• Providers in Yakima, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; 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.