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General NPI Number Information
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NPI Number | 1043321078
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Entity Type | Individual
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Provider Name | JEAN ANN CLARK MSRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 201 S PRESTON RD
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City | PROSPER
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State | TX
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Zip | 75078-8585
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Country | US
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Telephone | 972-347-6375
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Fax | 972-347-6375
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Provider Business Mailing Address
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Address Line | 201 S PRESTON RD
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City | PROSPER
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State | TX
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Zip | 75078-8585
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Country | US
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Telephone | 972-347-6375
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Fax | 972-347-6375
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 446522
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 446522
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License Number State | TX
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