Jacquelyn M Clark, RN

Primary specialty

Critical Care Medicine Registered NurseTaxonomy code 163WC0200X

License

RN450440 Issued in OH

Practice address

1228 Walnut St Apt 2
Cincinnati, OH 45202-7135

Phone

(513) 766-2631

NPI assigned

Mar 9, 2020

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583712000000",
    "number": "1598390635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14096",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452500096",
            "telephone_number": "513-766-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 WALNUT ST APT 2",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452027135",
            "telephone_number": "513-766-2631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JACQUELYN",
        "middle_name": "M",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-09",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "OH",
            "license": "RN450440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric C Clark
• Genevia Nichole Clark
• Gloria Hamm Clark
• Haley Clark
• Hannah Clark
• Jade Kiana Pearl Clark, MA CCC-SLP
• Jenesis E Clark, LPCC
• Jennifer Sue Clark, NP
• Jensine Juanita Clark
• Jesse L Clark

• Critical Care Medicine Registered Nurse in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Critical Care Medicine Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; 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.