Provider Demographics
NPI:1073505442
Name:CLARK, JESSICA J (PA C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:2525 KANEVILLE RD
Mailing Address - Street 2:FOX VALLEY ORTHOPAEDIC INSTITUTE
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2578
Mailing Address - Country:US
Mailing Address - Phone:630-584-1400
Mailing Address - Fax:630-584-1733
Practice Address - Street 1:2525 KANEVILLE RD
Practice Address - Street 2:FOX VALLEY ORTHOPAEDIC INSTITUTE
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2578
Practice Address - Country:US
Practice Address - Phone:630-584-1400
Practice Address - Fax:630-584-1733
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant