Jeri Lynn Clark, CPM, LM
Individual provider Active NPI Midwife · Lindale, TX
NPI 1902144207 · NPPES record last updated Jan 21, 2013
Key facts
- NPI
- 1902144207
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Midwife 176B00000X
- License
- 99166 (TX)
- Practice address
- 20158 FM 1253
Lindale, TX 75771-3402 - Phone
- (903) 787-9917
- NPI assigned
- Jan 21, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99166 | TX | MD | Midwife |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | 99166 | TX | Yes |
Addresses
Primary practice location
20158 FM 1253
Lindale, TX 75771-3402
Mailing address
20158 FM 1253
Lindale, TX 75771-3402
Phone (903) 787-9917
Other providers in Lindale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.