Jacob Alan Clark, MS, LAT, ATC

Athletic Trainer · Cisco, TX

Individual Active NPI

NPI number 1629695663

Practice location

101 College Hts
Cisco, TX 76437-1900
Phone
(254) 442-5198

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NPI record

NPI
1629695663
Entity type
Individual (Type 1)
Enumeration date
June 25, 2020
Last updated
June 25, 2020
Certified
June 25, 2020
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Athletic Trainer Primary 2255A2300X AT8111 TX

Mailing address

1645 PR 2431
Clyde, TX 79510-1900
Phone
(409) 489-2284

About Jacob Clark

Jacob Alan Clark, MS, LAT, ATC is a healthcare provider registered in the NPI registry with the primary taxonomy Athletic Trainer (code 2255A2300X). The practice location is 101 College Hts, Cisco, TX 76437-1900. The NPI number 1629695663 was assigned on June 25, 2020 and the record was last updated on June 25, 2020.

Jacob Clark lists a license in the registry: #AT8111 (TX) for Athletic Trainer. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jacob Alan Clark, MS, LAT, ATC?

The NPI number is 1629695663.

What is the phone number of Jacob Clark?

The phone number listed for the practice location is (254) 442-5198.

Where is Jacob Clark located?

101 College Hts, Cisco, TX 76437-1900.

What is the taxonomy code for Jacob Clark?

The primary taxonomy code is 2255A2300X – Athletic Trainer.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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