Healthcare Provider Details

I. General information

NPI: 1285240036
Provider Name (Legal Business Name): JAMES DANIEL CLARK DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BEAR CLARK DNP, APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18707 44TH PARK SE
BOTHELL WA
98012-7988
US

IV. Provider business mailing address

5608 17TH AVE NW STE 2024
SEATTLE WA
98107-5232
US

V. Phone/Fax

Practice location:
  • Phone: 564-234-3123
  • Fax:
Mailing address:
  • Phone: 564-234-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61135106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: