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Contact Information

JASON CLARK
620 SKYLINE DRIVE
JACKSON, TN38301
 Phone: 731-541-7070
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Anesthetist, Certified Registered

367500000X 43 Certified Registered Nurse Anesthetist (CRNA)
Indicates primary specialty

NPI Profile & details for JASON CLARK · (Male)

NPI # 1306197348
Status Active
Credentials
Entity Individual
Enumeration date 10/01/2012
Last updated 02/25/2026 - About 3 months ago
Sole proprietor 1 No
Identifiers
  • MS License # 810611
  • TN License # 16994
  • MS Medicaid 200025631
Hospital affiliation(s)
  • BAPTIST MEMORIAL HOSPITAL NORTH MS - (Acute Care)
    2301 SOUTH LAMAR
    OXFORD, MS 38655
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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