Jennifer Shae Clark, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1010436 Issued in TX

Practice address

215 Westside Dr Ste 200
Decatur, TX 76234-3869

Phone

(940) 273-5700

NPI assigned

May 5, 2021

Last updated

Jan 26, 2024By the provider in NPPES

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 TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitality Medical PLLCGroup PAC ID 5496122616, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CBGHDD/Endpoint/CBGHDD

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

• Vitality Medical PLLC

  • Family Nurse Practitioner
  • Decatur, TX
  • NPI 1588389779
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1295319374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 WESTSIDE DR STE 200",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343869",
            "telephone_number": "940-273-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 WESTSIDE DR STE 200",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343869",
            "telephone_number": "940-273-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "SHAE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-05",
        "last_updated": "2024-01-26",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1010436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delayna Choat, LMFT - A
• Chris McGee MD PA
• Christine Holland MD PA
• Christus Ventures PLLC
• Jenna D Clark, LPCA
• Baylee Alise Clemens, PA-C
• Robert K Clifford Jr., MD
• Lisa Lynn Cody, CRNA
• Sheree Nicole Colson, LAT, CSCS
• Columbia Medical Center of Denton Subsidiary LP (Medical City Denton)

• Family Nurse Practitioner in Decatur, TX
• Providers in Decatur, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.