Jessica Clark, DNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.0027330 Issued in OH

Practice address

1000 Atcheson St
Columbus, OH 43203-1353

Phone

(614) 252-4941

NPI assigned

Jun 16, 2018

Reactivated

Sep 23, 2020

Last updated

Jan 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/cndcolumbus/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community for New Direction

  • Community/Behavioral Health Agency
  • Columbus, OH
  • NPI 1730230343
  Medicare reassignment NPD
• Community for New Direction

  • Mental Health Counselor
  • Columbus, OH
  • NPI 1821584400
  NPD (past)

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

{
    "created_epoch": "1529107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1982198610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ATCHESON ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432031353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ATCHESON ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432031353",
            "telephone_number": "614-252-4941"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1791 Alum Creek Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432071757",
            "country_code": "US",
            "telephone_number": "614-445-8131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JESSICA",
        "credential": "DNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-16",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "deactivation_date": "2020-09-02",
        "reactivation_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "OH",
            "license": "RN.438874",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0027330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iesha Clark
• Inge Michelle Clark, LMT
• Janay Clark
• Janet Lee Clark, PH.D.
• Jennifer Rose Clark, M.D.
• Jill Suzanne Clark, PRS
• Jordan Clark, APRN-CNP
• Joreece Clark
• Joshua Alan Clark, DDS
• Karen Clark

• Psychiatric/Mental Health Nurse Practitioner in Columbus, OH
• Providers in Columbus, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.