Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 446522 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | 446522 | TX |
NPI | 1043321078 |
---|---|
Provider Name | Jean Ann Clark |
First Address | Prosper, TX 75078-8585 |
Second Address | Prosper, TX 75078-8585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/02/2019 |