Provider Demographics
NPI:1255136321
Name:CLARKSON, JAYNE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 NW WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8006
Mailing Address - Country:US
Mailing Address - Phone:913-636-2358
Mailing Address - Fax:
Practice Address - Street 1:1418 NW WILLOW DR
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8006
Practice Address - Country:US
Practice Address - Phone:913-636-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse