JENNIFER JUSTINA CLARK FNP-BC
NPI 1417596016
Nurse Practitioner - Family in Portland, OR
About Jennifer Justina Clark Fnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JENNIFER JUSTINA CLARK FNP-BC (NPI 1417596016) is an individual family provider in Portland, Oregon, licensed in Oregon (201908784NP-PP) and active in the NPI registry since December 2019. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jennifer Justina Clark Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 97239 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PORTLAND, OR 97239
PORTLAND, OR 97239
PORTLAND, OR 97239
PORTLAND, OR 97239
PORTLAND, OR 97239
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 Jennifer Clark's NPI number?
The NPI number for Jennifer Clark is 1417596016. It was assigned to this individual provider in the NPPES registry on December 30, 2019.
Where is Jennifer Clark located?
Jennifer Clark practices at 3710 SW Us Veterans Hospital Rd, Portland, OR 97239. The listed phone number is (503) 220-8262.
What is Jennifer Clark's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Jennifer Clark enrolled in Medicare?
Yes. Jennifer Clark is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Jennifer Clark was last updated on December 30, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Jennifer Justina Clark, FNP-BC · NPI 1417596016
Family physician in Portland, Oregon. Individual provider, active in the CMS NPPES registry since December 30, 2019.
## Identity
- **NPI:** 1417596016 (Entity type: Individual)
- **Enumerated:** December 30, 2019
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 201908784NP-PP (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 3710 SW US VETERANS HOSPITAL RD, Portland, OR 97239-2964
- **Phone:** (503) 220-8262
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** December 30, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1417596016) · Data from the CMS NPPES public registry.