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NPI Code Detail

MEDICARE: JENNIFER MORGAN CLARK DNP, PMHNP

MEDICARE: JENNIFER MORGAN CLARK DNP, PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner13282TN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner0024167709VA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner20752SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194933507
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MORGAN CLARK DNP, PMHNP
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 10 PATEWOOD DR STE 130
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-6317
Country : US
Telephone Number : 864-455-8988
Fax Number : 864-522-5555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 05/20/2021

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