Provider Demographics
NPI:1346047966
Name:CLARK, JACINDA (RN)
Entity type:Individual
Prefix:
First Name:JACINDA
Middle Name:
Last Name:CLARK
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78767 N LOOP RD
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97875-4570
Mailing Address - Country:US
Mailing Address - Phone:509-774-8887
Mailing Address - Fax:
Practice Address - Street 1:610 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6601
Practice Address - Country:US
Practice Address - Phone:541-667-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201403713RN163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency