Provider Demographics
NPI:1962054387
Name:CLARK, JESSICA LYNN (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
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Mailing Address - Street 1:3780 N BUFFALO ST STE 8
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3780 N BUFFALO ST STE 8
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1855
Practice Address - Country:US
Practice Address - Phone:716-210-6230
Practice Address - Fax:716-272-9263
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY402755171000000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171000000XOther Service ProvidersMilitary Health Care Provider