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JENATTE CLARK DERMATOLOGY PLLC
NPI 1225601164
Dermatology in Yakima, WA

Active since July 19, 2021
4209 TIETON DR STE 102, YAKIMA, WA 98908(509) 945-7777(509) 966-8812 Get Directions Write a Review

NPPES record last updated: July 19, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jenatte Clark Dermatology Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENATTE CLARK DERMATOLOGY PLLC (NPI 1225601164), doing business as Jenatte Clark Dermatology, is a healthcare organization registered as a dermatology in Yakima, Washington and active in the NPI registry since July 2021. The organization lists Jenatte Clark, Family Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1225601164
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameJENATTE CLARK DERMATOLOGY PLLC
Location Address4209 TIETON DR STE 102Yakima, WA 98908-3377
Mailing Address4209 Tieton Dr Ste 102Yakima, WA 98908-3377 · (509) 945-7777 · Fax (509) 966-8812
Phone(509) 945-7777
Fax(509) 966-8812
Organization SubpartNo
Authorized OfficialJenatte ClarkFamily Nurse Practitioner · (509) 945-7777
Enumeration DateJuly 19, 2021
NPPES CertifiedJuly 19, 2021
✔ NPI 1225601164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
4209 TIETON DR STE 102, Yakima, WA 98908
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Other Names 1

Doing Business AsJenatte Clark Dermatology

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jenatte Clark Dermatology Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Jenatte Clark Dermatology PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Shannon Bolt, ARNP
Nurse Practitioner
NPI 1083006522
4209 TIETON DR
Yakima, WA 98908
(509) 654-9810
✔ PECOS✔ Accepts MedicareSame address
Jenatte Clark, ARNP
Nurse Practitioner
NPI 1003250663
4209 TIETON DR STE 102
Yakima, WA 98908
(509) 654-9810
✔ PECOS✔ Accepts MedicareSame address
Caroline Clark, ARNP
Nurse Practitioner
NPI 1861586182
602 E NOB HILL BLVD
Yakima, WA 98901
(509) 248-3334
✔ PECOS3.5 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jenatte Clark Dermatology PLLC's NPI number?

The NPI number for Jenatte Clark Dermatology PLLC is 1225601164. It was assigned to this organization in the NPPES registry on July 19, 2021. The provider is doing business as Jenatte Clark Dermatology.

Where is Jenatte Clark Dermatology PLLC located?

Jenatte Clark Dermatology PLLC is located at 4209 Tieton Dr Ste 102, Yakima, WA 98908. The listed phone number is (509) 945-7777.

What is Jenatte Clark Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Jenatte Clark Dermatology PLLC enrolled in Medicare?

Yes. Jenatte Clark Dermatology PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jenatte Clark Dermatology PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Jenatte Clark Dermatology PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Jenatte Clark Dermatology PLLC was last updated on July 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.