{"npi":"1306197348","type":"NPI-1","status":"active","name":{"display":"Jason Clark","other":[],"first":"JASON","last":"CLARK"},"specialty":{"primary_taxonomy":"367500000X","primary_taxonomy_description":"Certified Registered Nurse Anesthetist","slug":"certified-registered-nurse-anesthetist","schema_org_specialty":null,"all":[{"code":"367500000X","description":"Certified Registered Nurse Anesthetist","primary":true,"state":"TN","license":"16994"},{"code":"367500000X","description":"Certified Registered Nurse Anesthetist","primary":false,"state":"MS","license":"810611"}]},"addresses":[{"purpose":"LOCATION","street_1":"620 SKYLINE DRIVE","city":"JACKSON","state":"TN","postal_code":"38301","country_code":"US","phone":"7315417070"},{"purpose":"MAILING","street_1":"620 SKYLINE DR","city":"JACKSON","state":"TN","postal_code":"383013923","country_code":"US"}],"license":{"state":"TN","number":"16994"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"200025631","state":"MS","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20121017000538","type_code":"14-43","type_desc":"PRACTITIONER - CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)","state":"TN","pac_id":"4284884834"},{"enrlmt_id":"I20141018000089","type_code":"14-43","type_desc":"PRACTITIONER - CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)","state":"MS","pac_id":"4284884834"}]},"enumeration_date":"2012-10-01","last_updated":"2026-02-25","_meta":{"source":"NPPES","snapshot_date":"2026-02-25","doc_url":"https://findmynpi.com/api"}}