Jenatte Virginia Clark
Dermatologist Nurse Practitioner - Family Medicine
4209 Tieton Dr Ste 102
Yakima
, Washington 98908-3377
Jenatte Virginia Clark
Dermatologist Nurse Practitioner - Family Medicine
4209 Tieton Dr Ste 102
Yakima
, Washington 98908-3377
(509) 966-8812
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About
Features
Specialties
- Dermatologist
- Nurse Practitioner - Family Medicine
Languages spoken
- English
Location
First Address
- Jenatte Virginia Clark
- 4209 Tieton Dr Ste 102
- Yakima, WA
- Zip : 98908-3377
- Fax : (509) 966-8812
- Phone : (509) 654-9810
Second Address
- Jenatte Virginia Clark
- 4209 Tieton Dr Ste 102
- Yakima, WA
- Zip : 98908-3377
- Fax : (509) 966-8812
- Phone : (509) 654-9810
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | AP60329890 | WA |
| N | 363LF0000X | Nurse Practitioner - Family Medicine | AP 60329890 | WA |
National Provider Identifier
| NPI | 1003250663 |
|---|---|
| Provider Name | Jenatte Virginia Clark |
| First Address | Yakima, WA 98908-3377 |
| Second Address | Yakima, WA 98908-3377 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/04/2013 |
| Last Update Date | 10/11/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.