{
"Npi": {
"NPI": "1598573313",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JESSICA CLARK, NP IN PSYCHIATRY PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3780 N BUFFALO ST STE 8",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORCHARD PARK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14127-1855",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-210-6230",
"MailingAddressFaxNumber": "716-272-9263",
"FirstLinePracticeLocationAddress": "3780 N BUFFALO ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORCHARD PARK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14127-1855",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-210-6230",
"PracticeLocationAddressFaxNumber": "716-272-9263",
"EnumerationDate": "12/26/2024",
"LastUpdateDate": "09/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARK",
"AuthorizedOfficialFirstName": "JESSICA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DNP",
"AuthorizedOfficialTelephoneNumber": "716-210-6230",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}