Clark, Jessica Dawn

Clark, Jessica Dawn is an individual health care provider with primary practice located at 87 Swierkos Dr , Moundsville WV 26041-4209. She recently has 2 registered licenses in different health care specialties including Nursing Service Related Providers / Attendant Care Provider, Nursing Service Related Providers / Personal Care Attendant. Nursing Service Related Providers / Personal Care Attendant is her primary health care specialty. Clark, Jessica Dawn can be contacted via phone (304) 843-0910.

Contact Information

Primary practice address
87 Swierkos Dr Moundsville WV 26041-4209
Phone: (304) 843-0910
Fax: (304) 843-0912
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Attendant Care Provider 3747A0650X West Virginia
Nursing Service Related Providers / Personal Care Attendant 3747P1801X

Profile Details

NPI number 1174190755
LBN Legal business name Clark, Jessica Dawn
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2021
Last updated Sep 26th, 2022 - about 3 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 1174190755 NPPES
West Virginia MEDICAID 1356607394
West Virginia MEDICAID 125553494
West Virginia MEDICAID 1821206228

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