Jonathan D Clark, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

3141 Issued in OK

Practice address

1011 Honor Heights Dr
Muskogee, OK 74401-1318

Phone

(189) 577-3000

NPI assigned

May 20, 2014

Last updated

Feb 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jon Clark Other 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": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1811308240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6731 E 131ST PL S",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740083302",
            "telephone_number": "918-605-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 HONOR HEIGHTS DR",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744011318",
            "telephone_number": "189-577-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JONATHAN",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-20",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "3141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1169860",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA MEDICAL LICENSE",
            "identifier": "3141",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JON",
            "last_name": "CLARK",
            "credential": "ATC, LAT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ryan Keith Christie, MD
• Cindy E. Durr, D.O., Inc., P.C. (Hope Kids Therapy)
• Ashley Nichole Clagg, BSN,RN
• David Stephen Clark, DDS
• James Clark
• Joyce A Clark
• Makyla Denise Clark
• Kelli Jo Clay
• Keith Edward Clayton II
• Vincient Cleamons, R.D.

• Surgical Physician Assistant in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Surgical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.