Healthcare Provider Details

I. General information

NPI: 1407780141
Provider Name (Legal Business Name): ERICA J CLARK PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 W MUIRWOOD DR
HERRIMAN UT
84096-8215
US

IV. Provider business mailing address

5709 W MUIRWOOD DR
HERRIMAN UT
84096-8215
US

V. Phone/Fax

Practice location:
  • Phone: 760-533-0447
  • Fax:
Mailing address:
  • Phone: 760-533-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12644807-8900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12644807-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: