Individual provider · Type 1 NPI
Jacob Clark, APRN, PMHNP-BC
Psychiatric/Mental Health Nurse Practitioner · Draper, UT
NPI number
1487009957
Active · reactivated Sep 29, 2022
Practice location
138 E 12300 S Unit 860
Draper, UT 84020-7976
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Other Technician | 247200000X | None listed |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 8480668-4405 (UT) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
Another provider at this address
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About NPI 1487009957
Jacob Clark, APRN, PMHNP-BC's National Provider Identifier is 1487009957, issued on May 3, 2016. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Draper, UT. The record was last updated on Oct 1, 2022.