Jalita Lauren Clark, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN070344 Issued in GA

Practice address

2100 Comer Ave
Columbus, GA 31904-8725

Phone

(706) 596-5583

NPI assigned

Jan 27, 2015

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

Other names 1

• Jalita Lauren Daniel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422316800000",
    "number": "1790175990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 TWELVE OAKS DR",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302419647",
            "telephone_number": "912-614-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 COMER AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319048725",
            "telephone_number": "706-596-5583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JALITA",
        "middle_name": "LAUREN",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "LPN070344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JALITA",
            "last_name": "DANIEL",
            "middle_name": "LAUREN",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brel Clark, OD, PC
• Brenda Clark
• Brett H Clark, PT
• Curtis E Clark Jr., DO
• Holly D. Clark
• Krystle Diane Clark, BCBA
• Linda Clark
• Meylon Tillman Clark
• Nicole Clark
• Shirley Rushing Clark, R.PH.

• Licensed Practical Nurse in Columbus, GA
• Providers in Columbus, GA by specialty
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; 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.