Clark, Jared Dale

Clark, Jared Dale is an sole proprietor health care provider with primary practice located at 4077 Jefferson Ave , Texarkana AR 71854-1509. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as his primary health care specialty. Clark, Jared Dale can be contacted via phone (870) 330-9200.

Contact Information

Primary practice address
4077 Jefferson Ave Texarkana AR 71854-1509
Phone: (870) 330-9200
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X AP141588 Texas

Profile Details

NPI number 1467011239
LBN Legal business name Clark, Jared Dale
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 6th, 2019
Last updated Aug 28th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467011239 NPPES
Texas Other AP141588 APN LICENSE

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