Jayson Clark
Individual provider Active NPI Driver · Lovington, NM
NPI 1992477871 · NPPES record last updated Dec 29, 2021
Key facts
- NPI
- 1992477871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 57850 (NM)
- Practice address
- 40 W Dickens Rd
Lovington, NM 88260-8715 - Phone
- (575) 659-4874
- NPI assigned
- Sep 29, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 57850 | NM | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DJS Transprotation LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 57850 | NM | Yes |
Addresses
Primary practice location
40 W Dickens Rd
Lovington, NM 88260-8715
Mailing address
40 W Dickens Rd
Lovington, NM 88260-8715
Phone (575) 659-4874
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 98781804 | Medicaid | NM |
Other providers in Lovington, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2021. 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.