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General NPI Number Information
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NPI Number | 1962054387
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Entity Type | Individual
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Provider Name | JESSICA LYNN CLARK DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 3780 N BUFFALO ST STE 8
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1855
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Country | US
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Telephone | 716-210-6230
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Fax | 716-272-9263
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Provider Business Mailing Address
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Address Line | 3780 N BUFFALO ST STE 8
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1855
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Country | US
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Telephone |
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 402755
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402755
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License Number State | NY
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