Individual ProviderJaquita B ClarkCommunity Health WorkerOther Service ProvidersPractice Address325 SW Frazier Ave, Topeka, KS 66606-1963(785) 232-5005PECOS EnrollmentBased on the most recent information from CMS, provider Jaquita B Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1033669668Provider TypeIndividualFull NameClark, Jaquita BGenderFemaleSole ProprietorNoEnumeration Date10/6/2016Last Updated10/6/2016Contact InformationPractice LocationPractice Address325 SW Frazier Ave, Topeka, KS 66606-1963Phone(785) 232-5005FaxUnlisted FaxMailing LocationMailing Address325 SW Frazier Ave, Topeka, KS 66606-1963Phone(785) 232-5005FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode172V00000XPrimaryDescriptionCommunity Health WorkerOther Service ProvidersLicenseUnlisted IssuerDelaware