Jordan Clark, PA-C
Individual provider Active NPI Physician Assistant · Fort Riley, KS
NPI 1336701911 · NPPES record last updated Dec 2, 2025
Key facts
- NPI
- 1336701911
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 15-02330 (KS)
- Practice address
- 650 Huebner Rd
Fort Riley, KS 66442-4030 - Phone
- (785) 239-3627
- NPI assigned
- Jul 3, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241111000927 | KS | Practitioner - Physician Assistant | 7618401878 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 15-02330 | KS | Yes |
Addresses
Primary practice location
650 Huebner Rd
Fort Riley, KS 66442-4030
Mailing address
BLDG 650 Huebner Rd
Fory Riley, KS 66442
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15-02330 | Other | KS | KSBHA |
Other providers in Fort Riley, KS
- Teressa D Chandler
- Erik Christensen
- Ebonie Christion
- Eric Chung
- Elizabeth Ann Cintron
- Howard Earl Coatney
- Jolee Marie Coberly
- Suzanne Webb Cobleigh
- Kimberly Coffee
- Nicole Renee Coffeen
All providers in Fort Riley, KS · Physician Assistant in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.