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NPI Code Detail

MEDICARE: DR. CLARK LINDSEY JENNINGS M.D.

MEDICARE: DR. CLARK LINDSEY JENNINGS M.D.
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
12084P0800XPsychiatry Physician30385CO

General Provider Information

NPI Number : 1760452908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLARK LINDSEY JENNINGS M.D.
Provider Business Mailing Address
First Line : 1414 N NEVADA AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7431
Country : US
Telephone Number : 719-475-8038
Fax Number : 719-475-0993
Provider Business Practice Location Address
First Line : 1414 N NEVADA AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7431
Country : US
Telephone Number : 719-475-8038
Fax Number : 719-475-0993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 10/22/2007

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