Clark, Jennifer Lynn

Clark, Jennifer Lynn is an individual health care provider with primary practice located at 4945 Williams Dr , Georgetown TX 78628-2008. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Clark, Jennifer Lynn can be contacted via phone (512) 819-0500.

Contact Information

Primary practice address
4945 Williams Dr Georgetown TX 78628-2008
Phone: (512) 819-0500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X L6327 Texas

Profile Details

NPI number 1003876095
LBN Legal business name Clark, Jennifer Lynn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2006
Last updated Jan 13th, 2021 - about 5 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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Identifiers

StateTypeNumberIssuer
All States NPI 1003876095 NPPES
Texas Other 8J9873 BLUE SHIELD
Texas MEDICAID 1598815-01 BLUE SHIELD
Texas Other 1598815-02 BLUE SHIELD
Texas Other P00053006 BLUE SHIELD

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