Healthcare Provider Details

I. General information

NPI: 1851202055
Provider Name (Legal Business Name): JAMES CLARK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GABRIEL CLARK

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13032 BITNEY SPRINGS RD
NEVADA CITY CA
95959-9017
US

IV. Provider business mailing address

13032 BITNEY SPRINGS RD
NEVADA CITY CA
95959-9017
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-7736
  • Fax:
Mailing address:
  • Phone: 530-273-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number1CC4B82F02
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: