Provider Demographics
NPI:1427666486
Name:CLARK, JONAS DEAN (MSN RN, AGAC-NP)
Entity type:Individual
Prefix:
First Name:JONAS
Middle Name:DEAN
Last Name:CLARK
Suffix:
Gender:M
Credentials:MSN RN, AGAC-NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22155 JORDAN RUN RD
Mailing Address - Street 2:
Mailing Address - City:GUYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45735-9594
Mailing Address - Country:US
Mailing Address - Phone:740-517-0674
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST STE 302
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-568-5207
Practice Address - Fax:740-568-5297
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027078363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner