Clark, Jacob

Clark, Jacob is an individual health care provider with primary practice located at 138 E 12300 S Unit 860 , Draper UT 84020-7976. He recently has 2 registered licenses in different health care specialties including Technologists, Technicians & Other Technical Service Providers / Technician, Other, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Clark, Jacob can be contacted via phone (801) 449-1429.

Contact Information

Primary practice address
138 E 12300 S Unit 860 Draper UT 84020-7976
Phone: (801) 449-1429
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Technologists, Technicians & Other Technical Service Providers / Technician, Other 247200000X
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 8480668-4405 Utah

Profile Details

NPI number 1487009957
LBN Legal business name Clark, Jacob
Credentials APRN, PMHNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2016
Last updated Oct 1st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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