Jennifer Rae Clark, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP142270 Issued in TX

Practice address

2800 E League City Pkwy Apt 216
League City, TX 77573-1676

Phone

(907) 350-8538

NPI assigned

Nov 13, 2019

Sex

Female

Sole proprietor

No

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

Enrolled in TX

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

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment NPD
• Privia Medical Group Gulf Coast PLLC

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1982249926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 FM 646 RD W STE 155",
            "city": "DICKINSON",
            "state": "TX",
            "postal_code": "775393256",
            "telephone_number": "907-350-8538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E LEAGUE CITY PKWY APT 216",
            "city": "LEAGUE CITY",
            "state": "TX",
            "postal_code": "775731676",
            "telephone_number": "907-350-8538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "RAE",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-13",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP142270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole A Christians, MD
• Christine Dolson D.D.S., P.a.
• Chronic Pain Institute
• Kayla Cisneros
• City of League City
• Natalie Elizabeth Clarkson, PHARMD
• Clear Creek Chiropractic Center
• Clear Creek Clinic,P.a.
• Clear Creek Counseling Center
• Clear Creek Emergency Room LLC

• Pediatric Nurse Practitioner in League City, TX
• Providers in League City, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; 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.