Provider Demographics
NPI:1861500654
Name:CLARKSON, JENKINS LUCAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JENKINS
Middle Name:LUCAS
Last Name:CLARKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 AVE H
Mailing Address - Street 2:POWELL VALLEY HEALTHCARE
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435
Mailing Address - Country:US
Mailing Address - Phone:307-754-7257
Mailing Address - Fax:307-754-1226
Practice Address - Street 1:450 MOUNTAIN VIEW
Practice Address - Street 2:POWELL VALLEY HEALTHCARE
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435
Practice Address - Country:US
Practice Address - Phone:307-754-7257
Practice Address - Fax:307-754-1226
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25997207V00000X
NC98-00815207V00000X
WY9432A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911641Medicaid
NC8911641Medicaid