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General NPI Number Information
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NPI Number | 1053887455
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Entity Type | Individual
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Provider Name | MARY ANGELYN JOVES CLARK MSN, APRN
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 177 LA CASA VIA STE 390
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City | WALNUT CREEK
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State | CA
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Zip | 94598-6101
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Country | US
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Telephone | 925-692-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 TREAT BLVD STE 300
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City | WALNUT CREEK
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State | CA
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Zip | 94597-2168
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Country | US
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Telephone | 925-952-2828
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP95009579
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95009579
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95068012
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95009579
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License Number State | CA
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